Issue: Health

A bill that purports to nullify parts of the Affordable Care Act (ACA) sailed through an Alabama Senate committee Wednesday with few questions. The bill now goes to the full Senate for consideration.

SB 220’s sponsor, Sen. Jerry Fielding, R-Sylacauga, told members of the Senate Judiciary Committee that he needed to pass the bill out of the committee Wednesday but said there would be a chance to make changes. “I have some changes myself,” Fielding said. “There will be opportunity for adjustments.”

The bill cites the Tenth Amendment to the U.S. Constitution in seeking to refuse to enforce sections of the ACA that “exceed the authority of Congress.” The measure does not specify all the parts of the ACA that are believed to exceed that authority. The U.S. Supreme Court upheld the ACA’s constitutionality in 2012.

Depending on how state officials would interpret the broadly worded SB 220 if it became law, enforcement might halt Alabama’s compliance with numerous technical provisions of the ACA, including new Medicaid eligibility requirements, information system upgrades and interagency data sharing. Disrupting such activities could jeopardize current federal Medicaid funding, ACPP policy director Jim Carnes said.

SB 220 would authorize the attorney general to file lawsuits on behalf of certain individuals or businesses “being harmed by implementation” of the ACA. The measure also would prohibit Alabama or any of its cities or counties from establishing a health insurance exchange under the ACA.

In addition, the bill would forbid state agencies and employees from conducting “involuntary” home visits under certain maternal, infant and early childhood programs referenced in the ACA. The ACA already requires that all such visits be voluntary. If SB 220 bars all in-home visits under that section of the ACA, the Department of Children’s Affairs could lose $6.3 million a year in federal grants, according to the Legislative Fiscal Office.

Committee member Sen. Phil Williams, R-Rainbow City, asked whether the bill’s passage could void certain insurance contracts already in force. Fielding said he would welcome a floor amendment to address that concern.

Identical legislation – HB 147, sponsored by Rep. Barry Moore, R-Enterprise – awaits action in the House Health Committee. The Legislature will return Thursday for the 16th of 30 allowable meeting days during the 2014 regular session, which is expected to last until early April.

By M.J. Ellington, health policy analyst. Posted Feb. 19, 2014.

Pharmacies that dispense HIV medications for or in HIV clinics would be able to redistribute certain unopened drugs under a bill that the House Health Committee approved unanimously Wednesday. HB 138, sponsored by Rep. Patricia Todd, D-Birmingham, now moves to the full House.

Current regulations prohibit HIV clinics from sending back medications, Todd said, even if patients do not show up for treatment. Clinic doctors say there are ample opportunities to use unclaimed, unopened drugs for other patients, but state regulations do not permit unauthorized redistribution of such drugs. Without the changes proposed in HB 138, pharmacies must continue to destroy those drugs.

Todd’s bill would allow pharmacies to redispense the medications to other patientsand would set strict control measures on handling and oversight of the drugs. State law already allowscounty jails and prisons to redispense unused prescription drugs and gives oncologists theauthority to use unclaimed cancer drugs for other patients.

Arise and other consumer advocates last year urged Gov. Robert Bentley to support this policy change as his Medicaid Pharmacy Study Commission met to look at ways to reduce costs in the state’s Medicaid drug assistance programs. Advocates said the change would reduce waste and improve cost-effectiveness. Funding for most HIV medications comes from federal sources to the AIDS Drug Assistance Program at the state Department of Public Health.

The Legislature will return Thursday for the 14th of 30 allowable meeting days during the 2014 regular session, which is expected to last until early April.

By M.J. Ellington, health policy analyst. Posted Feb. 12, 2014.

An Alabama law that guarantees health insurance coverage for some people without regard to their health status is on the fast track to obsolescence in the Legislature.

Sponsors of identical House and Senate bills that would end the Alabama Health Insurance Plan (AHIP) say the program no longer will be needed because the Affordable Care Act (ACA) requires insurers to offer coverage regardless of a person’s health history.

HB 66, sponsored by Rep. Steve Clouse, R-Ozark, passed in the House last month and cleared a Senate committee Wednesday. The bill now awaits Senate approval. Meanwhile, a House committee Wednesday approved SB 123, sponsored by Sen. Slade Blackwell, R-Mountain Brook, putting the bill in line for a House floor vote.

The bills would reactivate AHIP if federal law ever again requires Alabama to offer so-called “guaranteed-issue” coverage. The measures would transfer any unobligated plan funds to the General Fund. They also could eliminate the need for the AHIP assessment on insurers, which raised $10.6 million last year, according to the Legislative Fiscal Office.

Before the ACA, insurers often refused to cover applicants with pre-existing conditions like cancer. Alabama created AHIP as a high-risk pool to cover certain residents who were turned down by other insurers after Congress passed the Health Insurance Portability and Accountability Act (HIPAA).

State Insurance Department figures show that AHIP enrollment has dropped significantly since the ACA took effect, Clouse said. AHIP’s highest enrollment was 1,800 people, but the most recent count of the plan’s participants was 640, he said.

By M.J. Ellington, health policy analyst. Posted Feb. 5, 2014.