The Ferguson Group Blog

Wednesday News Roundup

Every Wednesday, The Ferguson Group (TFG) blog posts a series of articles published over the previous week that discusses topics of interest to local governments. Learn about emerging trends and keep up on key policy issues by browsing the TFG Wednesday News Roundup!

 

White House Delays Health Insurance Mandate For Medium-sized Employers Until 2016

 

Under new rules released Monday by the U.S. Treasury and the Internal Revenue Service, employers with 50 to 99 employees will be given until 2016 before they are responsible for paying a employer shared responsibility penalty if they don’t offer their full-time workers health insurance. The mandate gives mid-sized employers an extra year to comply with the regulations. However, employers with 100 or more employees will still be required to begin implementing these new regulations starting in 2015.Read More…

 

What Government Can Learn From Colleges About Transportation Policy

 

A new report, released by the Frontier Group and the U.S. Public Interest Research Group, suggests that transportation policies on college campuses could help cities promote public transportation, and bike and car sharing programs in their communities.  The report authors argue that cities and colleges share some of the same incentives for reducing car-related commuting, such as reducing congestion, promoting efficient land use, attracting youth to the area, and reducing environmental impacts. Read More…   

 

Philly Teaches Officials With New Innovation Academy

 

Philadelphia is taking municipal innovation to the classroom by enrolling 19 of the city’s officials in a new eight-week program that aspires to institutionalize some of the processes and ideas driving government innovation. The Municipal Innovation Academy was designed in partnership with Philadelphia University, which is currently piloting its own undergraduate innovation program. The Municipal Innovation Academy will have lessons ranging from the basics of innovative thinking, to more advanced principles such as design thinking, the use of analytics, systems thinking, and problem solving strategy.Read More…

 

FEMA: Caught Between Climate Change and Congress

 

As we have seen in the past few years, FEMA has had to deal with its fair share of extreme weather disasters, and the agency has had a hard time keeping up. Some experts say that the agency is failing to properly account for climate change when planning its yearly budget and resource allocations, which is one of several critical reasons FEMA is struggling to function. Another impediment to FEMA's functionality is an annual budget that has roughly stayed the same since the 1980's. The budget can only increase at the hand of Congress, and that prospect looks grim.Read More…

 

Latest Senate Attempt to Revive Jobless Benefits Falters

 

On February 6^th, the Senate failed to move forward on a three-month extension of long-term unemployment benefits (S. 1845), falling one vote short of the 60 votes needed to proceed. Senate Majority Leader Harry Reid has not said when he will schedule another vote on S. 1845.  Meanwhile, Reid moved S. 1963, a bill restoring earned retirement pay for military retirees. The Senate will likely revisit the legislation upon its return from the week-long President’s Day recess.Read More…

ACA Treatment for HIV+ People

Stakeholders are voicing strong concerns that some health insurers are failing to provide minimum standards of coverage for people who are HIV+. A coalition of 31 HIV/AIDS organizations reached out to the White House and the Department of Health and Human Services (HHS) on December 2, calling on them to launch an investigation into whether insurers are discouraging HIV+ people from signing up on their plans. The biggest concern is for people living in states that have federally-run exchanges. The groups maintain that such practices would be illegal under the Affordable Care Act (ACA) provisions that ban discrimination against people with pre-existing medical conditions. Having HIV or AIDS would qualify.  Several plans fail to cover critical HIV drugs. The group singled out an insurer that, in Florida, mandates 50% of the cost share for HIV drugs, and sums at these rates could amount to thousands of dollars in out-of-pocket expenses. Some insurers have responded by saying that they offer a variety of plans at a different levels of coverage.  HHS says that they are looking into the matter.  With ACA coverage beginning as early as January 1 for some, this matter’s urgency is apparent.

Bill Seeks to End HIV Discrimination

Legislation introduced recently would expand federal programs to review and seek to end policies and laws that criminalize the transmission of HIV and lead to our sources of discrimination against HIV+ people. On Monday, Senator Chris Coons (D-DE) introduced the “Repeal Existing Policies that Encourage and Allow Legal (“REPEAL”) HIV Discrimination Act,” which would require an interagency review of federal and state laws that criminalize certain actions by people living with HIV. It is companion legislation to a bill introduced this summer by Representative Barbara Lee (D-CA), a champion of HIV/AIDS issues in the Congress.  

Activist and advocates say that the legislation is urgently needed since 32 states have laws that in various ways use a person’s HIV status to help with criminal convictions. The laws date back to the passage in 1990 of the Ryan White CARE Act, the first national response to the AIDS epidemic. The Care Act included a requirement that states criminalize the transmission of HIV as a pre-condition for receiving funding. Less than half of the states and territories have subsequently repealed those provisions (no longer required to receive Ryan White funds). Senator Coons said, “There are places in this country where state and local laws make it similar to assault with a deadly weapon for somebody with HIV/AIDS to spit on someone, for example. That’s based on an outdated unscientific fear that fed lots of discrimination.” The Center for HIV Law and Policy completed a study showing that in the past two years, there have been 80 know prosecutions “in which HIV-positive people have been arrested and/or prosecuted for consensual sex, biting, and spitting.”  Recent passage of the HOPE Act, bi-partisan bill that allowed organ donations among HIV+ people, has given congressional sponsors and activists encouragement that the REPEAL Act can be passed and sent to the President for signature. The HOPE Act passed by unanimous consent in both chambers. 

White House says it met November 30th deadline for healthcare marketplace website update

Briefing the media on Sunday, the Obama Administration announced that it substantively met its goal of making the healthcare.gov website operational, allowing it to handle a larger volume of traffic and permit individuals to sign up for health insurance in the federally-run healthcare marketplaces in states that are not running their own exchanges. The White House touted new numbers that showed it signed up over 100,000 people for coverage in November. That figure far eclipsed the paltry number of people who were able to sign up in October, at the launch month, when it was stymied by a failed system. The White House said that more than 750,000 visitor hit the site on Monday, the first business day after the relaunch.

People who want coverage starting January 1, 2014 will have until December 23rd to sign up and pay the initial premium for their plan. All others who are required to use the exchanges to secure health insurance will have until March. President Obama announced that he will secure coverage for him and his family by signing up on the Washington, DC exchange. States that are running their own exchanges report surges in sign ups as well, although HHS has yet to provide an updated aggregate nationwide figure.  

HIV/AIDS services and sequestration

Two of the largest of HIV/AIDS service organizations (amfAR and NMAC) released a new infographic illustrating the potential impact of sequestration in Fiscal Year 2014, should it be allowed to go into effect.  These estimates are based on the latest publicly available data on budget allocations and unit costs. Applying a 7.3% cut to these programs through sequestration would have a serious impact on people living with HIV/AIDS, particularly people of color, who are disproportionately affected by the epidemic. saving medications to manage their HIV viral load, with 65% of those being people of color. 

The states that suffer the most include California, Florida, Texas, New York, Georgia, New Jersey, and Illinois.  Should sequester be allowed to continue, the NIH will face a $229 million cut to highly consequential research on HIV and AIDS.  Several studies document that HIV+ people who regularly adhere to their medical regimes and who have secure housing and employment can effectively manage the disease over long periods of time.  The biggest causes of lack of adherence are housing and employment instability.  Taking away the ability of highly vulnerable populations' ability to administer their health care and remain stable drives new infections.  It ultimately produced higher medical costs for the poor and indigent. 

http://www.amfar.org/impact-of-fy14-budget-sequestration-on-us-funded-global-health-programs/

Conflicting Data on Affordable Care Act (ACA)

How to sort through the conflicting information on the Affordable Care Act and how it’s impacting President Obama’s second term? With so much information celebrating the bill and criticizing its implementation and effect on health care coverage, it is no wonder the public is either confused or now opposed to it. 

Here are a few points of analysis.  Several states (including California, Kentucky, Connecticut, and Maryland) are on track to make or exceed their enrollment targets for state exchanges that they run.  Data is not yet public on enrollment in states where the federal government runs the exchange, and the White House denies media reports that enrollment is far behind anticipated levels. 

HHS is saying that improvements to the healthcare.gov website are being made daily.  Regardless of the improvements, the President’s job approval is suffering, apparently due to the very public failure of the exchange roll out.  It is currently at 42 percent according to a poll by the Washington Post and ABC News.  A Reuters news poll found that 59% of Americans now oppose the ACA. 

Currently, the tension shows no sign of dissipating.  The public is increasingly skeptical of ACA but more and more people are signing up for coverage under the exchanges. 

 

Affordable Care Act - Public/Stakeholders Wait for Numbers

With all the problems with the healthcare.gov website, the “technological glitches,” the “tech surge,” and even an apology from the President, Obamacare’s supporters and detractors await solid, verifiable numbers on how many Americans are actually signed up for coverage under the Affordable Care Act. Over a dozen states have successfully set up their own health care exchanges. The U.S. Department of Health and Human Services (HHS), despite the website problems, is still actually signing up some people for insurance coverage, most of that done manually.  HHS officials have yet to announce official numbers from the federally-run and state-run exchanges. HHS Secretary Kathleen Sebelius did warn congressional committees before which she testified that the numbers would not be what is desired. California, the state with the largest exchange and expected to have the largest number of enrollees, has yet to release its enrollment data. Critics suspect that this is due to the machinations of the Obama Administration. White House officials say that they want to ensure that the data is true and verifiable and that is difficult working with over a dozen different systems. On Friday, HHS will close the application period for its latest round awards to help states build, maintain, and expand their insurance exchanges.

 

 

Will Sebelius Resign?

Facing mounting criticism from multiple corners, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius faces numerous calls from Obamacare critics and opponents to resign.  During a CNN interview that aired last week, she refused to comment on whether she offered the President her resignation.  The landscape for her departure and the confirmation of a replacement would be rocky at best.  Moreover, her replacement would require Senate confirmation, a prospect that the White House and Obamacare abhor.  The White House continues to voice support publicly for Secretary Sebelius and there are no reports that she or the President want her to leave.  

 

President Takes Charge of Website Debacle

This morning, President Obama tackled the debacle over the malfunctioning website that was supposed to allow people to sign up on the
health care exchanges established under the Affordable Care Act.  Enrollment began on October 1st,
but healthcare.gov has reportedly been unable to actually enroll anyone in the federally-run health care exchanges.  Several states that are running their own exchanges have been able to
find ways to actually enroll people, but the one maintained by the U.S. Department of Health and Human Services has not.   From the White House Rose Garden, the
President said that he had enlisted the nation’s top government IT solutions experts to fix the “glitches” and get the system fully operational.  "There's no sugar-coating it. The website has been
too slow, people have been getting stuck during the application process," he said.   He also shared that Secretary Sebelius would be testifying before Congress to explain what went wrong and how
it is being fixed, just not this week as the House Energy and Commerce Committee had demanded.   Pressure to fix the system is mounting.  While criticism from the laws opponents has
been expected, even House Minority Leader Nancy Pelois (D-CA) called the problems “unacceptable.”

Let’s Shift to Medicaid and Away from Exchanges

While the “glitches” and problems with the start of enrollment for the state health care exchanges grab the attention of the press, the drama around the expansion of Medicaid continues to unfold.  New reports from the Kaiser Family Foundation suggest that the Affordable Care Act is succeeding in reducing the rate of state spending on Medicaid, as costs rise more slowly.  There are 25 states that have accepted the federally funded Medicaid expansion and their average rate of increase in spending is 4.4%.  States that are not participating are seeing their costs rise 6.1% on average.  Some participating states say that their overall net spending will decrease, due in large part to the federal government covering 100% of the cost of expansion in the initial years. 

This good news still has a shadow side.  Washington, DC announced that they would suspect provider payments under its Medicaid program because of the current federal government shut down. Unlike most states, DC’s expenditures are contingent on explicit permission from the federal government.  Even so, the contingency fund it established has insufficient reserves to carry the program.  Arizona Governor Jan Brewer (R) is still defending her decision to expand Medicaid against opponents in the state legislature, including fighting a lawsuit from a legislator and the Goldwater Institute.  And Alaska may be the last holdout in deciding on whether to expand the program.  Governor Sean Parnell told the state press that he would make a final decision by Christmas, right before the deadline to accept federal funding.