STATE SYS­TEM OF THE

With the coun­try watch­ing, Obama has the chance to pro­pel ACA’s in­surance en­roll­ment ef­fort

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What Obama needs to say now about health­care

Ptor’s big­gest groups, in­clud­ing Sis­ter Carol Kee­han, pres­i­dent and CEO of the Catholic Health As­so­ci­a­tion, and Richard Umb­den­stock, pres­i­dent and CEO of the Amer­i­can Hospi­tal As­so­ci­a­tion.

“En­roll Amer­ica is go­ing to play a strong lead­er­ship role and will work closely with a very sub­stan­tial num­ber of or­ga­ni­za­tions and with the pub­lic sec­tor, in­clud­ing with the ad­min­is­tra­tion and states,” Pollack said in an in­ter­view.

The ad­min­is­tra­tion’s sec­ond ma­jor health­care task this year is im­ple­men­ta­tion of the com­plex cov­er­age sys­tems to which it is driv­ing new en­rollees. Of­fi­cials face daunt­ing lo­gis­ti­cal chal­lenges as they at­tempt to ex­e­cute a his­toric Med­i­caid ex­pan­sion by 2014 and cre­ate func­tional health in­surance ex­changes for peo­ple to be­gin en­rolling in eight months from now. And that re­quires coax­ing many states that have balked at go­ing along with one or both of those pro­vi­sions.

The lack of ac­tion so far on in­surance ex­changes in many states has left the ad­min­is­tra­tion scram­bling to or­ga­nize about 30 fed­er­ally run ex­changes. That is far more than was en­vi­sioned by the au­thors of the health law and may stretch the CMS to the break­ing point, said Bruce Vladeck, former ad­min­is­tra­tor of the CMS’ pre­de­ces­sor agency un­der Pres­i­dent Bill Clin­ton.

“No one bud­geted for the CMS to run ex­changes in 30-some states,” he said.

The fed­eral government may need to step in if states fail this year to im­ple­ment ma­jor statu­tory changes to their lo­cal health in­surance rules, said Sara Collins, a vice pres­i­dent at the Com­mon­wealth Fund. The law re­quires changes in each state’s rules for in­surance sold out­side of the ex­changes, such as new lim­i­ta­tions on the use of ben­e­fi­cia­ries’ ages to set the price of in­surance poli­cies.

“If it’s not done, then the feds would need to step in and do it for them,” Collins said.

All of this will oc­cur in the face of con­tin­ued Repub­li­can op­po­si­tion to the un­der­ly­ing health­care over­haul. De­spite some Repub­li­can gov­er­nors re­luc­tantly em­brac­ing as­pects of the health­care law in their states, con­gres­sional Repub­li­can lead­ers re­mained com­mit­ted to un­rav­el­ing a law they see as a res­i­dent Barack Obama rarely makes much men­tion of health­care in his an­nual key­note speeches, but this week he could use the fo­rum to help launch a his­toric en­roll­ment ef­fort. The rel­a­tively few health­care ref­er­ences in the pres­i­dent’s four pre­vi­ous State of the Union ad­dresses came de­spite health­care re­form as Obama’s lead­ing domestic pol­icy goal and then sig­na­ture leg­isla­tive achieve­ment.

That could change, said health pol­icy ex­perts, with the fi­nal ad­dress be­fore the cov­er­age ex­pan­sion au­tho­rized by the Pa­tient Pro­tec­tion and Af­ford­able Care Act launches later this year. In­form­ing an es­ti­mated 27 mil­lion of the na­tion’s 58 mil­lion unin­sured ci­ti­zens that they are newly el­i­gi­ble for some type of in­surance cov­er­age is seen as one of the Obama ad­min­is­tra­tion’s big­gest chal­lenges in 2013.

“That’s just a her­culean task that we have been pre­par­ing for since ba­si­cally the leg­is­la­tion was passed and signed into law,” said David Lem­mon, com­mu­ni­ca­tions di­rec­tor for the lib­eral con­sumer ad­vo­cacy group Fam­i­lies USA.

His group and oth­ers have launched ed­u­ca­tional cam­paigns some­times in tan­dem with grow­ing en­roll­ment ef­forts by the Obama ad­min­is­tra­tion. Those ef­forts are needed, pol­icy ex­perts said, be­cause if younger, health­ier en­rollees do not sign up, then costs of the new cov­er­age sys­tem will fall on older, sicker Amer­i­cans.

Fam­i­lies USA Ex­ec­u­tive Di­rec­tor Ron Pollack is lead­ing one such group, En­roll Amer­ica, which he said will spend “tens of mil­lions of dol­lars” this year on a pub­lic­ity cam­paign aimed at more than three-quar­ters of the unin­sured who do not know they are el­i­gi­ble for cov­er­age. That group’s board of direc­tors in­cludes many lead­ers of the health­care sec-

mas­sive ex­pan­sion of fed­eral power and an un­sus­tain­able long-term en­ti­tle­ment.

“Congress is loom­ing over all of this and wait­ing for it to fail,” said Mar­i­lyn Moon, se­nior vice pres­i­dent and di­rec­tor of the Health Pro­gram at the Amer­i­can In­sti­tutes of Re­search.

Obama also is ex­pected to face ris­ing pres­sure in 2013 to un­der­take a sig­nif­i­cant fed­eral debt-re­duc­tion ef­fort that slows the growth of fed­eral health­care pro­grams. The pres­i­dent could re­spond to Repub­li­can de­mands for mov­ing Medi­care to a pre­mium sup­port model or shift­ing Med­i­caid to state block grants with ac­cel­er­ated im­ple­men­ta­tion of Medi­care cost-sav­ing pi­lots con­tained in the re­form law, said some health pol­icy ex­perts.

“It’s a mat­ter of how do you move from vol­un­tary pi­lots to an ac­tual change in the pay­ment ap­proach that would suc­ceed,” said Paul Gins­burg, pres­i­dent of the Cen­ter for Study­ing Health Sys­tem Change.

Obama also could push re­duc­ing the tax ex­clu­siv­ity for em­ployer-pro­vided health in­surance, Gins­burg said. Although such tax changes are highly con­tro­ver­sial, they may pro­vide the ba­sis for the ad­min­is­tra­tion to find at least a small amount of bi­par­ti­san agree­ment this year.

“That’s very con­sis­tent with the in­ter­est in both po­lit­i­cal par­ties in broad­en­ing the tax base and clos­ing loop­holes,” he said.

Trustees of the Year for 2013

Far­rell

Howard

Reno

Pres­i­dent Barack Obama doesn’t usu­ally say much about health­care in the State of the Union ad­dress. Will he this time?

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