“If there’s to be a train wreck, we governors would rather be spectators than conductors.”
Govs. Haley Barbour of Mississippi, Bobby Jindal of Louisiana, Mary Fallin of Oklahoma, Robert Bentley of Alabama and Rick Perry of Texas, among others, signed the letter.
Sebelius took to the opinion pages of the Washington Post on Feb. 9 to respond, arguing that the law already allows for ample local oversight. “What these critics miss is that the law already gives states most of the resources and flexibility they’re asking for,” she wrote.
Legal experts say the governors are taking a two-pronged approach in their fight against the reform law. “While pursuing having this rolled back in the courts, they are pursuing a rollback in the political arena,” said James Napoli, senior counsel at the law firm Proskauer Rose in Washington. “I think what we are seeing with these letters is the states exerting their political will and staking out their political positions.”
Some Republican governors also have sought to change their Medicaid programs. Last week, Utah Gov. Gary Herbert met with CMS officials to request a waiver to charge some beneficiaries’ higher co-pays and link provider reimbursements with care quality. Florida and Arizona also are seeking Medicaid waivers.
Utah is one of only two states already operating an insurance exchange. The Utah program, where about 1,000 workers have accessed insurance, “demonstrates that states can use market principles to solve difficult issues in healthcare,” Herbert said in a speech last week at the Heritage Foundation.
Mitch Daniels, the Republican governor of Indiana, has been one of the most vocal critics of the law. “If there’s to be a train wreck, we governors would rather be spectators than conductors,” Daniels wrote last week in the Wall Street Journal. Daniels and Herbert were among the 21 governors who signed the letter to HHS on the exchanges.
The governors also asked Sebelius for a new independent analysis on how many residents in each state are expected to seek coverage through the exchanges, how many will join Medicaid rolls and what the cost will be to the states. In 2014, Medicaid eligibility will expand to households with incomes up to 133% of the federal poverty level, compared with 100% of the federal poverty level currently required.
The states are concerned about the administrative burden of “churn” between the two programs. Within a year of the exchanges being operational, half of adults with family incomes below 200% of federal poverty will shift between the exchanges and Medicaid, or 28 million people, according to a study published in Health Affairs last week.
On another key point, the 21 governors want full authority to decide what types of health benefits will be offered to consumers in the exchanges. HHS is expected to issue rules this spring on these minimum benefit requirements for health plans operating in the exchanges.
Napoli said the minimum benefit package rules are an area where the Obama administration and the governors might have room to negotiate. “That’s one issue where there could be some compromise,” he said.