States get 644-page health re­form guide

Se­be­lius says there’s flex­i­bil­ity in start­ing in­sur­ance ex­changes

The Washington Times Daily - - Politics - BY PAIGE WIN­FIELD CUN­NING­HAM

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.

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