After spending the past month in their home districts listening to constituents, this week House and Senate members are back in Washington and Congress is back in session. Though the attention of many has turned to back-to-school, back-to-football, and to remembering the events of September 11 and making difficult decisions on Syria, it is not far from anyone’s mind that open enrollment begins in less than one month. The Obama administration is immersed in an all-out push to promote the Affordable Care Act (ACA): The administration is planning a $12 million ad buy in key states, this past weekend Enroll America hosted more than 200 events across the country to promote the ACA, and the Baltimore Ravens have been recruited to help push enrollment in Maryland. Additionally, regulations implementing the Affordable Care Act continue to be released, the Centers for Medicare and Medicaid Services (CMS) has been preparing to inform insurance issuers of their statuses as Qualified Health Providers, the Committee on Energy and Commerce held an ACA hearing on September 10, Senators Rand Paul, Mike Lee and Ted Cruz headlined the “Exempt America Tour” rally on September 10, and the Medicare Payment Advisory Commission will meet to discuss Accountable Care Organizations, Medicare Advantage, dual eligibiles and Medicare Part D on September 12 and 13.

AT THE AGENCIES

The Internal Revenue Service (IRS) issued a proposed rule for the reporting requirements employers will have to meet under Section 6056 of the ACA, which requires employers to report to the IRS information about their compliance with the employer shared responsibility requirements. Enforcement of the employer mandate was delayed earlier this summer until 2015.

In another proposed rule, the IRS detailed how employers and insurers who provide coverage will report to the government which individuals had what type of insurance and when, so the government can determine who is and is not complying with the ACA’s individual mandate.

On August 30, CMS released the third guidance letter for state Medicaid directors on potential paths for Medicaid shared savings programs. In the first two letters, CMS described the framework for Integrated Care Models and pathways that states may use to implement them in their Medicaid state plans or appropriate waivers and demonstrations. The third letter discusses reimbursement methodologies that can be adopted in the context of Integrated Care Models to incentivize improved quality and outcomes and reduce costs.

On September 6, it became public news that CMS program integrity chief Peter Budetti will leave his post as CMS’s first deputy administrator and director for program integrity.

CMS informed issuers of their qualified health plan (QHP) certification statuses on September 9. Further updates to come.

AT THE WHITE HOUSE

The Obama administration is planning a $12 million ad buy to promote the Affordable Care Act. The advertisements are reported to begin airing on September 30 in Arizona, Florida, Georgia, Indiana, Louisiana, Michigan, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee and Texas, states that are largely led by Republicans and in many cases have been hostile to the ACA.

ON THE HILL

On September 6, the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) released a score of the House bill to delay the individual and employer mandates by a year, H.R. 2668. The CBO and JCT estimate that the legislation would reduce federal deficits by roughly $36 billion over the 2015-2018 period and by roughly $35 billion over the 2014-2023 period.

The House Committee on Energy and Commerce’s Subcommittee on Health held a hearing on September 10 on the ACA’s “Implementation Challenges for States and Job Creators.”

Unions are becoming increasingly frustrated with a general lack of response from the Obama administration to their concerns as changes are made in implementation to respond to concerns of businesses, churches and other religious groups, and Capitol Hill. Unions argue that the ACA could cut employee hours, that Taft-Hartley health plans will be ineligible for subsidies because they are multiemployer plans, and that workers will be forced off their union health plans into the law’s potentially more costly insurance exchanges. On September 5, Chairman of the House Ways and Means Committee Dave Camp (R-Mich.) and Chairman of the Education and Workforce Committee John Kline (R-Minn.) sent a letter to the CBO and JCT requesting estimates on the cost of providing insurance subsidies to union-sponsored insurance plans.

Republicans on the House Committee on Energy and Commerce sent a records request to several groups that were recently named health care navigators requesting details about their organization and instructing the groups to schedule congressional briefings within the next two weeks. Rep. Henry Waxman (D-Calif.) wrote a letter arguing that these requests were an abuse of authority. On September 9, HHS sent a response to Energy and Commerce House members providing information on the navigator grant recipients.

IN THE STATES

Following the Michigan Senate’s approval of Medicaid expansion last month, the Michigan House approved Medicaid expansion last week. A bill will now be sent to Governor Snyder for signature. Governor Snyder (R) has been pushing for Medicaid expansion in his state despite previous resistance from a Republican-led state legislature. The bill would go into effect 90 days after the current session concludes in December if Gov. Snyder signs it.

On September 3, CMS agreed to allow Indiana to extend an existing program the state has for low-income residents, known as the Healthy Indiana Plan, until at least the end of 2014. Some view this as an indication that the state will expand its Medicaid program under the ACA.

On September 6, CMS approved a one-year extension of Oklahoma's Insure Oklahoma demonstration, which is an existing demonstration to help low-income adults afford health coverage. The demonstration was set to expire at the end of the year.

On September 3, Maryland health officials announced a new partnership with the Baltimore Ravens to promote Maryland’s insurance marketplace.

IN THIRD PARTIES

Enroll America organized 1,000 volunteers to hold more than 200 events across the country to promote the ACA this past weekend. The efforts focused attention on Arizona, Florida, Georgia, Illinois, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania and Texas.

On September 4, the Republican National Committee (RNC) launched a new website and video that highlight local news stories on the cost of insurance under the ACA. The website also features a to-the-second countdown to the “Obamacare Train Wreck.”

On September 4 speaking in Arkansas, former President Bill Clinton urged Congress to revise several issues presented by the ACA. He highlighted an error in the law that prevents a full-time employee’s family from getting subsidized health insurance on the exchange if the individual’s policy is affordable. Clinton also criticized those states that were not taking advantage of incentives for Medicaid funds. He praised Arkansas’ private option Medicaid plan that enables some Medicaid-eligible individuals to use premium assistance to purchase qualified health plans on the state’s exchange.

IN THE COURTS

On September 5, Liberty University filed a petition asking the Supreme Court to review the 4th Circuit Court of Appeals’ decision in Liberty’s case seeking to overturn the ACA’s requirement that employers provide health insurance that covers contraception.

To view our compilation of recent health care reform implementation news, click here.