Health reform implementation

After months of hearing Republican governors complain about the healthcare reform law, President Obama challenged all of the nation's governors to come up with their own healthcare proposals on Monday.

Speaking to the state leaders, Obama threw his support behind a bipartisan Senate bill that would accelerate the reform's waivers for states that want to try innovative healthcare programs that offer coverage as expansive and affordable as it is under the healthcare law. The waivers, which would be start in 2014 instead of 2017, would give the states the chance to propose alternatives, including options to replace the unpopular individual mandate. Read The Hill story.

House GOP hates it: House Republicans, eager to undo the law, labeled the president's announcement an admission of the law's failure. "It is just making our point that not only have we seen a variety of exceptions and waivers issued to the private sector under the act but now we’re seeing how that act is troubling states in a real way," House Majority Leader Eric Cantor (R-Va.) told reporters Monday.

Liberals say President Obama’s support for accelerating state waivers for the healthcare reform law creates new opportunity for the federal government to back more liberal healthcare policies rejected during past debate over the reform law.

Obama on Monday endorsed a Senate bill that allows states to seek earlier exemptions from the reform law in order to build their own healthcare systems that meet the law’s coverage and affordability goals. The federal law currently provides the waiver option in 2017, but Obama is backing a bill from Sens. Ron Wyden (D-Ore.), Scott Brown (R-Mass.) and Mary Landrieu (D-La.) that would move the date up to 2014.

The original healthcare reform bill included a public-option insurance plan to compete with the private market, but it was dropped months before the final law passed. Consumer Watchdog said the accelerated waiver program gives liberal states the leeway to implement more progressive reforms.

“State waivers give progressive reformers in California and elsewhere the ability to move forward on ambitious reform plans that can pass at the ballot box in 24 states but would never get the time of day in Washington,” Consumer Watchdog President Jamie Court said in a statement.

House Majority Leader Eric Cantor (R-Va.) said President Obama’s support for allowing states to opt out of the healthcare law three years early “makes the case” that Republicans have made against the entire law.

Obama announced Monday that he would favor a bipartisan Senate proposal that would allow states to seek an exemption waiver beginning in 2014 instead of 2017, as the 2010 law mandates. States would have to demonstrate that their own programs satisfy the federal law's coverage and affordability requirements.

“It is just making our point,” Cantor told reporters Monday, “that not only have we seen a variety of exceptions and waivers issued to the private sector under the act but now we’re seeing how that act is troubling states in a real way.”

“I think it just makes the case that we’re trying to make here,” the majority leader added. “The ObamaCare bill is something that is an impediment to job growth. It is something that seems to be an impediment to states now getting their fiscal house in order.”

Cantor reiterated that the GOP commitment is to repeal the law entirely. The House passed a repeal bill in January, but the Senate voted it down. The structure of the Democratic overhaul is “unworkable,” Cantor said.

Did the Florida judge who struck down the reform law in January mean to halt its implementation, or didn’t he? U.S. District Judge Roger Vinson is expected to make his intent explicit next week following an Obama administration request to clarify his Jan. 31 ruling.

The 26 states and business group who successfully challenged the law said this week that Vinson clearly meant to halt the law, and they accused the administration of making a thinly-veiled attempt of trying to get a stay of the decision. The administration has the opportunity to respond to the states by Monday, and Vinson said he will weigh in “promptly.”

When lawmakers return from Presidents Day recess, their top priority will be trying to keep the government running past March 4. House Republicans passed a seven-month continuing resolution that would choke off funding to implement healthcare reform and Planned Parenthood, but Senate Democrats likely won’t be willing to entertain those cuts. The defunding measures can play a huge role in whether a government shutdown can be avoided.

The Constitution grants the federal government wide latitude to impose taxes — but not penalties — for general welfare.

A two-week, stopgap continuing resolution (CR) proposed by House Republicans includes more than $450 million in cuts to the Department of Health and Human Services, but it avoids hot-button issues such as funding for healthcare reform and Title X family planning.

The CR unveiled Friday afternoon includes $4 billion in reductions and is meant to avoid a government shutdown that would occur on March 4 without both chambers and President Obama agreeing to a spending bill.

A seven-month resolution passed by the House last week included $61 billion in cuts and provisions that would halt funding for healthcare reform, Title X family planning and Planned Parenthood. Senate Democrats are not likely to include those cuts in their spending bill, which could trigger a fight with Republicans in the lower chamber.

As unhappy governors protest they can't afford the law's Medicaid requirements, HHS stresses law's flexibility.

Battle over control of health law's exchanges roils North Carolina: A bruising battle over who gets to control a key element of Democrats' healthcare reform law has broken out in North Carolina, providing an early glimpse into an issue that's likely to consume many state legislatures over the next two years.

The law gives states until the end of next year to create health insurance exchanges where people can buy high-quality insurance plans with federal subsidies starting Jan. 1, 2014. In states that aren't ready by then, the federal government will run the exchanges.

Consumer advocates in the Tar Heel State are accusing the state's biggest insurer, Blue Cross and Blue Shield of North Carolina (BCBSNC), of attempting to control the board that would regulate the exchange. They say legislation supported by the insurer would give Blue Cross a permanent seat at the table and weaken the exchange's consumer protections. Read The Hill's story.

New money for rate review: The Department of Health and Human Services announced $200 million in new grants for states to enhance their rate review procedures. $150 million will go toward two- and three-year grants to boost reviews. $22 million will go to states with greater populations. And $27 million in bonuses will be paid for states that create programs that have the power to block unreasonable rates, Healthwatch's Jason Millman reports. 

And still more money: HHS also announced that $100 million is available for states to incentivize healthy behaviors among Medicaid recipients. Read The Hill's write-up.

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A bruising battle over who gets to control a key element of Democrats' healthcare reform law has broken out in North Carolina, providing an early glimpse into an issue that's likely to consume many state legislatures over the next two years.

The law gives states until the end of next year to create health insurance exchanges where people can buy insurance plans with federal subsidies starting Jan. 1, 2014. In states that aren't ready by then, the federal government will run the exchanges.

Consumer advocates in the Tar Heel State are accusing the state's biggest insurer, Blue Cross and Blue Shield of North Carolina (BCBSNC), of attempting to control the board that would regulate the exchange. They say legislation supported by the insurer would give Blue Cross a permanent seat at the table and weaken the exchange's consumer protections.

The advocates are particularly peeved because they say they'd been led to believe that the insurance industry was collaborating with other stakeholders in drafting exchange guidelines under the auspices of the North Carolina Institute of Medicine. Instead, they were caught off guard last week when a Republican state representative introduced legislation that advocates say greatly favors BCBSNC.

"They went behind out backs and filed a terrible piece of legislation," said Adam Linker of the liberal North Carolina Justice Center.

The nation’s top five health insurers made nearly $12 billion in profits last year, according to a senior House Democrat.

The insurers – UnitedHealth, WellPoint, Aetna, Humana and Cigna – were more profitable than the top five firms in the energy, construction, aviation, motor vehicle and part manufacturing industries, according to a new fact sheet from Rep. Pete Stark (D-Calif.).

According to Stark, three of the insurers padded their profits by more than $3.5 billion by boosting premiums. Meanwhile, Stark said, Aetna and WellPoint padded their profits by $800 million by spending less on medical care.