Weekly Health Care Wrap-Up
Election Leaves President Obama in White House, Democrats in Senate, Republicans in House
The balance of power in Washington, DC remains unchanged following Tuesday’s elections, with President Obama winning re-election, Democrats maintaining control in the Senate and Republicans holding their majority in the House. Specifically, the 113th Congress will see 53 Democrats, 45 Republicans and 2 Independents in the Senate. The final division in the House remains unclear, with several House races still outstanding; however, it appears Democrats will likely gain seats, but still leave House Speaker John Boehner with a sizeable majority. In the Senate, all eyes will be on Maine Independent Senator-Elect Angus King who has yet to decide if he will caucus with Republicans or Democrats. The Senate’s other Independent, Bernie Sanders, caucuses with the Democrats. For more information on the 2012 election and for a recap of the MLA Campaign Textbook Series, visit our blog here.
Congress returns to Washington, DC next week, where the focus will be the looming Fiscal Cliff. Meanwhile, health care industry insiders will focus on several key committees of jurisdiction over the coming weeks, with vacancies to be filled on the Senate Finance Committee and other shuffling likely in light of retirements, election losses and leadership term limits. Stay tuned.
Key Regulations Arrive at OMB
In what is likely to be the beginning of a flurry of regulations related to the Affordable Care Act (ACA), rules related to Essential Health Benefits and actuarial value have landed at the Office of Management and Budget (OMB) for review. It remains unclear if the timeline for implementation of the ACA will shift over the coming weeks and months; however, HHS issued its first delay todaywith regard to the deadlines surrounding exchanges. Nevertheless, stakeholders should expect a host of regulations in the near term related to the health care reform law.
From the States
A complete roundup of this week’s action in the states is available through ourState of the States: Health Insurance Exchanges publication here.
Republicans continue to control a majority of statehouses and legislatures following Tuesday’s election. Specifically, 30 states and 26 legislatures are under Republican control, compared to 18 and 19 respectively for Democrats, with Washington’s gubernatorial race still undecided.
Meanwhile, states will face a host of questions and decisions related to the ACA over the coming weeks. States are in the process of determining their approach to exchanges under the ACA, while it remains unclear how many states will expand Medicaid under the law. Moreover, states continue to wait for guidance regarding essential health benefits and are in the process of responding to final regulations released last week on the Medicaid primary care increase.
Health Insurance Exchanges: State of the States update
With Tuesday’s elections behind us and today’s letter from HHS Secretary Kathleen Sebelius, states now have additional time to evaluate their exchange options and notify HHS if their choice is to pursue a state-based exchange, a partnership exchange with the federal government, or have the fall-back of a federally-facilitated exchange operate in their state. Previously states that had delayed making a formal exchange decision were racing to evaluate their options and submit their Blueprint by next Friday, November 16. Today’s letter from Secretary Sebelius gives states that are interested in applying for a federal-state partnership exchange until February 15, 2013 to submit both their Declaration Letters and Blueprints. States pursuing a state-based exchange still need to notify HHS of their intention by November 16 via Declaration Letter, but now have until December 14, 2012 to submit their Blueprint. In her letter, Secretary Sebelius also wrote that HHS intends to issue additional guidance in the near future. A copy of the letter is included in our PDF.
These new deadlines give governors and legislators additional time to reevaluate their stance on the exchange issue, something that many governors have requested. Here’s a brief post-election recap of what some of the nation’s governors have said regarding their exchange plans:
Kansas: In a statement released Thursday afternoon, Governor Sam Brownback (R) said that his state would not pursue a federal-state partnership. Brownback said in the release, “My administration will not partner with the federal government to create a state-federal partnership insurance exchange because we will not benefit from it and implementing it could costs Kansas taxpayers millions of dollars.” The announcement came shortly after Governor Brownback met with Insurance Commissioner Sandy Praeger and informed her of his decision. In preparation for the November 16 deadline, Commissioner Praeger had been preparing to submit a Blueprint application seeking federal approval to enter into a federal-state partnership.
Missouri: With voters passing a referendum that gives the choice over exchanges firmly to the state’s legislature, Governor Jay Nixon (D) has few options ahead of the November 16 deadline. “Based on the constraints of federal law and the quickly approaching federal deadline, the only option for Missouri at this time is to indicate that we will be unable to proceed with the state-based exchange – absent a change in circumstances,” said Nixon. After the 2012 elections, both the House and Senate remain under Republican control. Tom Dempsey, the newly nominated Senate President Pro Tem, said on Thursday that Republican legislators plan to discuss the exchange issue next week during a private meeting.
Nebraska: After Tuesday’s election, Governor Dave Heineman (R) said that he is still unsure which exchange option Nebraska would pursue and that he will take his time to make a decision. “We know one piece of the puzzle,” said Heineman. As Governor Heineman considers his options, the state has taken some steps toward an exchange. In particular, Nebraska released an RFP to procure an IT system for the exchange on October 15.
Ohio: On Thursday, Greg Moody, director of the Governor’s Office of Health Transformation, told reporters “By November 16 we have to send a Blueprint indicating our direction, and we’re leaning toward that being a federal exchange with the state retaining some authority to oversee health plans.” Moody also said that Ohio would like to retain the authority to regulate health insurers and determine eligibility for the state’s Medicaid program.
Tennessee: On Wednesday, Governor Bill Haslam (R) told reporters that he would be evaluating his options before making a decision on exchanges. In reference to the looming November 16 deadline to submit a Blueprint to HHS, he told reporters, “We’re going to take the nine days to look for answers and do our homework and then we’ll make a decision.” Previously, Governor Haslam expressed interest in Tennessee running its own exchange, but that view found little support in the state legislature. However, in his comments on Wednesday, he expressed the role of the legislature in potentially creating a state-based exchange saying, “If we say yes, it still has to have the legislature approve it, and we could also then anytime back out and change our mind.”
Virginia: In a press conference on Wednesday, Governor Bob McDonnell (R) said that Virginia would have a federally facilitated exchange. “At this point, without further information, the only logical decision for us is to use the federal option.”
Wisconsin: Governor Scott Walker (R) has been meeting with various cabinet officials this week to determine what to do about the state’s health insurance exchange. After meeting with advisors on Wednesday, Governor Walker told reporters that he was torn on the exchange issue. “There’s a part of me that looks at a state-run [exchange] and says, ‘I don’t want to give up anything I don’t have to [give up] to the federal government,’ just instinctively,” Walker said. But at the same conference with reporters, he also said “It might be a better argument to let it be run by the federal government because the risk you run is if a state runs it and eventually money goes away from the federal government, you might expose state taxpayers to picking up more of that cost.” Wisconsin’s exchange planning halted earlier this year under direct order from Governor Walker.
New Mexico: Finally, last Friday afternoon, the New Mexico Health Insurance Alliance (NMHIA), on behalf of the State of New Mexico, released an IT RFP to procure a state-based exchange. In the RFP, the State of New Mexico is seeking vendors to manage the information technology and systems integration for the implementation and establishment of a state-based Health Insurance Exchange (NMHIX). The NMHIX solution will include services for eligibility, enrollment, Small Business Health Options Plan (SHOP), and “shop and compare” information technology systems. Responses are due by November 30 and NMHIA is aiming to award the contract by January 7, 2013. Publicly, Governor Susana Martinez (R) has not announced whether she intends for New Mexico to develop an exchange, but she has expressed support for the concept of an exchange in the past, despite vetoing legislation to create an exchange in April 2011. At the time, Governor Martinez said she vetoed the legislation because it was not clear how much an exchange would cost. Since Tuesday’s election, the Governor has not made a statement on her exchange decision.
Wondering which states have submitted Declaration Letters so far? This week’s map shows which states have submitted Declaration Letters or have entered into serious, public discussions with HHS on forming a partnership exchange.