States get 644-page health reform guide
Sebelius says there’s flexibility in starting insurance exchanges
The Obama administration released more than 600 pages of guidance on Monday outlining a flexible framework for how states should go about enrolling uninsured Americans in new insurance exchanges under the president’s healthcare overhaul.
Secretary of Health and Human Services Kathleen Sebelius said the rule leaves plenty of room for states to choose an approach that works best for them, saying they can decide key questions for themselves — like whether to operate the exchange as a nonprofit organization or a public agency and how to decide which plans can participate.
“These policies give states the flexibility they need to design an exchange that works for them,” Mrs. Sebelius said. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs, and exchanges will give individuals and small businesses the same purchasing power big businesses have today.”
Faced with the massive administrative challenge of implementing President Obama’s health care law, HHS has stressed flexibility as it guides states toward setting up insurance exchanges where some 30 million Americans will be able to shop for plans that provide essential benefits and obtain federal subsidies to help pay for them.
States also face a series of logistical hurdles if they want to set up their own exchange by the January 2014 deadline instead of relying on a federal exchange.
They must create an efficient system to determine who qualifies to participate in the exchange, figure out whether they’re eligible for any subsidies and enroll them in a plan that meets all the essential coverage requirements outlined in the health care law.
While some states immediately started working toward an exchange when the law was passed in 2010, others are dragging their feet and some refuse to act until the Supreme Court rules on constitutional challenges to the law or after the November election.
Under the newest rule, states will have more time to set up exchanges so that even if they don’t achieve certification by the January 2013 deadline, they could still receive “conditional approval” by demonstrating progress. If they still aren’t ready by 2014, and the federal government steps in, states may still apply to assume oversight later.
States can also decide how to admit plans to the exchange, either by letting any plan meeting the standards of minimum coverage participate, or by having plans compete to participate. They can choose between using an application form provided by the federal government or designing their own. They can also decide whether large employers with more 100 employees will be allowed to shop in the exchange beginning in 2017.
State officials offered mixed reactions to the rule. Some complained that the administration is leaving too many questions unanswered, making it difficult for them to meet the deadlines outlined in the law, while others applauded the agency’s approach.
“I think what it does is give states the opportunity to be the laboratories of democracy,” said Kansas Insurance Commissioner Sandy Praeger, who has also served as president of the National Association of Insurance Commissioners. “It allows states to build on what currently exists in their state. I think the state flexibility is a very good thing.”
Virginia Secretary of Health and Human Services Bill Hazel said that while he wouldn’t criticize HHS for its approach to an “almost impossible task,” he would like to see the deadlines pushed back by at least six months — even though he said Virginia has “as good a chance as any” to get an exchange up and running by 2014.
He said he won’t know whether Virginia has enough information to move ahead on an exchange until he reads the rule — all 644 pages of it.
“We’ll read through the rules and see what questions they answer and then we have to fill in the blanks for the rest,” Mr. Hazel said.
Meanwhile, Karen Ignagni, president of America’s Health Insurance Plans, said she looks forward to reviewing the rule and praised it for handing states some autonomy in meeting the requirements of the health care law.
“This rule recognizes that states are in the best position to establish exchanges because they have the experience and local market knowledge needed to best meet consumers’ needs,” she said. “States need to be given flexibility to ensure that individuals, families and small businesses have access to options that work best for them.”
Proposed bipartisan legislation that would stop Congress from getting paid if they fail to pass a budget on time is winning fans on and off Capitol Hill.
The list of co-sponsors and endorsements is growing for identical House and Senate “No Budget, No Pay” bills introduced in December by Rep. Jim Cooper, Tennessee Democrat, and Sen. Dean Heller, Nevada Republican.
Mr. Cooper’s bill has 34 co- sponsors equally divided by party. The list has grow nsignificantly in recent days, with more than 20 co-sponsors added since Feb. 1.
The conservative Democratic Blue Dog Coalition, of which Mr. Cooper is a member, last month also endorsed the measure.
“In the last six decades Congress has passed a budget a mere four times,” said Rep. Kurt Schrader, Oregon Democrat, chairman of the group’s task force on fiscal responsibility.
“If this body can’t find a way to do what we have been sent here to do by the American people, which is to cut spending and reduce our nation’s outrageous $15 trillion deficit, then we don’t deserve to get paid.”
Of Mr. Heller’s six co-sponsors, two have joined since mid-february. One of the bill’s co-signers is a Democrat; Sen. Joe Manchin III of West Virginia.
The measures would prohibit lawmakers from receiving pay after missing deadlines for budget and appropriations bills. It would not allow for that pay to be recouped.
The measure has been endorsed by the taxpayer-watchdog group Council for Citizens Against Government Waste, the freemarket organization Americans for Prosperity and the centrist group No Labels.
“It is absurd that this legislation is needed to establish an incentive for lawmakers to do their jobs, but nothing else seems to be working,” said Council President Thomas A. Schatz in a letter to the two lawmakers last week. “Congress should no longer be allowed to avoid its responsibilities and kick the can down the road through the use of stopgap financial measures.”
Congress hasn’t passed an annual budget since 2009, despite a statutory obligation to do so by the end of every September. Instead, lawmakers — mired in partisan gridlock and distracted by the 2010 and 2012 elections — have passed a series of shortterm spending extensions.
The Republican-controlled House passed a budget last year, but it failed to clear the Democrat run Senate.
Despite the bipartisan support, leaders of the majority party in each chamber haven’t rallied behind the proposal.
Senate Majority Leader Harry Reid, Nevada Democrat, last month said he doesn’t intend to bring a budget to the floor for a vote this year, arguing that last summer’s debt-limit agreement — which set discretionary spending limits for fiscal year 2013 — in essence serves as a de facto budget.
And while a senior House GOP aide said the legislation appeared to be a good idea, don’t expect it to hit the floor for a vote anytime soon.
“The House always passes a budget — are we supposed to dock our members’ pay, which is frozen, anyway, because the Senate doesn’t do its job?” the aide asked rhetorically.
Mr. Heller and Mr. Cooper are scheduled to discuss their proposal as witnesses before a Senate Homeland Security and Government Affairs Committee hearing Wednesday on congressional-reform proposals.