Thread: States move to implement health care law

States move to implement health care law

By Kelly Kennedy, USA TODAY
Posted 3h 41m ago |

WASHINGTON — As House GOP members introduce legislation to defund the federal health care law, and thus, block its implementation, the states have applied for grants, built model health care exchanges and written legislation to comply with key aspects of the law.

Even in a number of states where the governors have signed letters and onto lawsuits calling for the end of the federal health care law, officials have claimed portions of the law that they like as well as millions of dollars in grant money to implement the legislation.

Publicly, talk centers on lawsuits and waiting to see whether the Supreme Court takes up the new law to determine whether it — specifically an individual mandate to have health insurance — is constitutional. But the states must "hedge their bets" in case the law isn't struck down, Republican Alabama state Rep. Greg Wren said.

TIMELINE: The road to healthcare legislation
Wren serves as co-chair of the federal health reform implementation committee of the National Conference of State Legislatures and said the organization has encouraged states to take the money, implement what they have to by law and take advantage of things they want — such as health exchanges without individual mandates. State are also encouraged to write legislation in such a way that they have an out if the federal law is struck down.

"I might support repeal-and-replace, but I'm a pragmatic, and I don't want to get caught flatfooted," Wren said. If they don't apply for grants, they risk having to pull money from badly depleted state budgets to pay for implementation planning. If they don't write legislation this session, they risk being forced to take part in federal health exchange programs — a marketplace where uninsured individuals and small businesses can comparison shop for insurance policies — rather than building their own. Some provisions of the law, passed last spring, have already gone into effect. But key provisions, such as the individual mandate, don't take effect until 2014.

"States historically have been much more pragmatic than ideological," said Drew Altman, president of the non-partisan Kaiser Family Foundation. "They may be ideologically opposed to the federal law, but pragmatism trumps ideology."

He said the states would take the grant money and then work to gain flexibility within the federal program. So far, Health and Human Services has awarded $2.45 billion in grants to the states.

"They're going to move forward, but it will be with something they can morph and brand as their own," he said.

Some states, such as Pennsylvania, have already convened dozens of planning meetings, while others, such as Illinois, have created legislation that would allow state administrators more control over insurance rate increases. California has already created an exchange that will begin operating in 2014.

On the other end of the scale, Florida's governor, Republican Rick Scott, has said he doesn't want to push implementation until he knows what will happen to the law. And others, such as Alabama and South Carolina, have not yet written legislation to create exchanges, though Wren said Alabama is working on it.

So far, 46 states and the District of Columbia have accepted federal million-dollar planning grants. Alaska did not apply for federal grant money, and Florida, Wisconsin and New Hampshire rejected it after a federal court judge there ruled the new health care law unconstitutional. The states are using federal grant money to build websites to provide information about their programs, create committees to write legislation, buy software to determine who is eligible for Medicaid, and begin the rate review process of insurers within their states.

After a slow start, enrollment in the Pre-existing Condition Insurance Plan increased by 50% in the past three months to more than 12,000 Americans. As of Feb. 1, Pennsylvania topped the list for most-enrolled with 2,046 people. The Congressional Budget Office estimated that 200,000 to 400,000 people could enroll in the program by the end of this year.

Mississippi was the first state to introduce legislation this session to create a health care exchange, but without mentioning the federal law at all. Seven states have shown interest in the legislation so far, said Cheryl Smith, director of the exchange practice portion of Leavitt Partners, a health care operation run by Mike Leavitt, former Health and Human Services secretary for President George W. Bush. Smith called Mississippi's legislation "pretty much flawless." Wren said the Mississippi legislation has been held out as a model to other states wary of implementation, including Alabama.

"The GOP can't support, quote, 'ObamaCare,' " she said. "They need to claim it as their own. Politically, it gets people on board."

Wren said legislation can be written to allow for opt-outs of the individual mandate should the federal law be struck down.

"The option of sitting back and doing nothing is a recipe for failure," he said. "None of us has a crystal ball."

http://www.usatoday.com/news/washington ... tion_N.htm

Feb 17, 2011

Alaska governor says he won't implement U.S. health care law

06:57 PM

Alaska's Republican governor says he won't implement the federal health care law, which a federal judge in Florida ruled unconstitutional two weeks ago.

Addressing the weekly luncheon of the Juneau Chamber of Commerce today, Gov. Sean Parnell said the state, which was one of 26 states behind the Florida lawsuit, would pursue "lawful, market-based solutions to making insurance affordable and accessible to Alaskans," the Associated Press writes. He called the Florida ruling "the law of the land, as it pertains to Alaska," AP says. Another federal judge has also found parts of the law unconstitutional, and two other federal judges have declared the overhaul constitutional.

After today's remarks, Parnell's office issued a press release saying the state would not apply for federal money to implement the law.

Some provisions of the law, which President Obama signed last March, have been implemented, with other major provision to come over the next three years, including the requirement that all Americans have health insurance or pay a fine. (See how the law might affect you.)

AP notes that about 14% of Alaskans are uninsured year-round. It's not yet entirely clear how the governor's decision will affect state residents. In his press release, Parnell said the state's insurance division is "reviewing the potential for developing a health insurance exchange without federal dollars." The agency is "evaluating data and software applications that could be used to create an Internet portal to provide better insurance information and more health care access."

http://content.usatoday.com/communities ... care-law/1