Will they or won't they?
The potential complexities surrounding state decisions over whether to expand their Medicaid programs now that the Supreme Court justices have eliminated fiscal penalties for not doing so continue to emerge. The law required Medicaid eligibility for all people with incomes up to 133% of the federal poverty level with a 5% leeway up to 138%.
The latest wrinkle in the expansion question was highlighted Tuesday by Matt Salo, executive director of the National Association of Medicaid Directors. He reminded attendees at a Washington health policy event that regardless of what various governors decide to do with their states' Medicaid programs, any decision may be countermanded by their legislatures.
But as a starting point to understanding where states are headed on the size of their Medicaid programs, Modern Healthcare recently contacted all 50 governors about their plans, as they stand now.
We asked whether states were planning to expand; planning to not expand; or undecided on expansion.
Here are the positions of the 26 governors' offices that responded, including several that specified they were waiting for the outcome of the November presidential and congressional elections.
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With much of the national attention focused on the largest moving parts of the 2010 federal healthcare overhaul, it's easy for the numerous smaller provisions to get lost in the shuffle. But the ongoing political battle over the fate of the law also has affected those initiatives.
One such small part of the 2,700-page law but big to providers was the new National Health Care Workforce Commission.
The first federally appointed advisory body fully focused on the healthcare workforce had its inaugural 15 members appointed by the comptroller general last year. But nothing else has happened with the group since then because Congress never approved any operational funds for it.
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There must be something about the July heat in Washington that gets House Republicans fired up about the Independent Payment Advisory Board, a yet-to-be appointed panel the 2010 healthcare reform law created to control the per-capita growth rate in Medicare.
A year ago this week, HHS Secretary Kathleen Sebelius testified before two House committees to answer questions about the purpose and merits of the 15-member board. And this week—on the same day the House voted a second time to repeal the entire Affordable Care Act—Rep. Phil Roe (R-Tenn.), a physician, sent a letter to the AARP that asked the organizations representing America's seniors to publicly support repealing the board.
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After the U.S. Supreme Court's ruling last week on the healthcare reform law, providers and payers can resume their focus on pending federal regulations. But they shouldn't hold their breath that HHS will release those rules before the November elections.
Voters will visit the polls in four months, which doesn't leave much time for HHS to issue some of the complicated regulations that healthcare providers and payers have anticipated. I spoke about this issue recently with Anne Hance and Eric Zimmerman, partners at the Washington office of law firm McDermott, Will and Emery. As Hance explained, these regulations include a proposed or final rule on essential health benefit packages that the Affordable Care Act requires of health plans. HHS has released two bulletins to offer the industry some guidance on essential health benefits, but they were not actual regulations and they generated many questions for the industry.
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That didn't take long.
In the 24 hours since the U.S. Supreme Court ruled to uphold the Affordable Care Act, former Massachusetts Gov. Mitt Romney raised more than $4 million for his presidential campaign.
“Thanks for everyone's support for #Full Repeal!” Andrea Saul, Romney's campaign press secretary, Tweeted Friday. Saul noted that the GOP presidential hopeful raised $4.6 million in more than 47,000 online donations since the SCOTUS ruling.
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Supporters and opponents of the 2010 federal healthcare overhaul have been engaged in a furious war of words in recent weeks over whether the law could stand without the individual mandate. But the apparent attempt to influence the thinking of the U.S. Supreme Court justices appears to be based on a flimsy premise.
Underlying the root of the arguments over whether the law could or should stand without the individual mandate is the broadly acknowledged reality that the mandate is both extremely unpopular by itself and also the least popular of the law's many provisions.
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Some congressional Democrats have blamed their historic 2010 losses on their lack of campaigning on the healthcare law—enacted with only Democratic support. But in recent months, other congressional Democrats have publicly urged their colleagues facing re-election this year to avoid a repeat of that mistake by aggressively campaigning on the law.
One senior Democrat not urging congressional Democrats to tout the law's many popular provisions is one of its primary authors.
I recently asked Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, if Democrats should be running on the healthcare law—his law—in this election.
“That's up to each candidate; up to each senator,” he said in a brief interview. “My personal belief—I can only speak for myself—I stoutly defend it and I think the court's going to approve it.”
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So what did Sen. Max Baucus (D-Mont.) say when HHS Secretary Kathleen Sebelius asked him to hold a confirmation hearing for Marilyn Tavenner, acting administrator of CMS?
“It's going to be difficult to proceed with the Republican opposition,” said Baucus, chairman of the powerful Finance Committee, when I asked him about the conversation.
The expected strong Republican opposition to Tavenner also has been his public explanation for his decision not to bring her confirmation up for a vote. The scenario echoed similar widespread Republican hostility to her predecessor, Dr. Donald Berwick, who stepped down in December after Baucus demurred giving him a confirmation vote.
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Attendees at the American Hospital Association's annual meeting last month heard from Richard Pollack, the group's executive vice president, about the need to push Congress to pass legislation that would extend certain Medicare provisions set to expire later this year.
On Wednesday, Pollack sent letters to every member of the House and Senate that outlined the various provisions the hospital industry would like to see extended.
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Congressional Democrats—and one independent—are lending their support to a new HHS pilot study that will review the current policy prohibiting gay and bisexual men from donating blood.
Two years ago this month, Sen. John Kerry (D-Mass.) and Rep. Mike Quigley (D-Ill.) sent a letter to HHS about this issue and have led an effort to overturn a policy—imposed in the 1980s in response to the AIDS epidemic—that bans any male who has had sex with another man since 1977 from giving blood. The lawmakers contend that technological advances in blood testing, as well as opposition from the blood bank community, are reasons to rethink this policy.
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Add another influential Washington figure whose family is directly benefitting from provisions of the healthcare overhaul. But this time it's someone who actually supports the law.
Sen. Scott Brown (R-Mass.) made news last month when he acknowledged that his 23-year-old daughter qualified for coverage under his congressional insurance policy because of the law's requirement that insurers cover any adult child up to 26 years old who applies for coverage. Brown famously campaigned as what was then believed to be the key vote to stop the Patient Protection and Affordable Care Act from passing the Senate.
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