Sebelius tries to soothe state worries about health reform

Health and Human Services Secretary Kathleen Sebelius is trying to soothe the fiscal and administrative concerns of officials in states who have considerable power in implementing the nation's attempt at health reform, The Wall Street Journal reports. "The law puts heavy demands on Ms. Sebelius — it has more than 1,000 references to actions that the 'secretary shall' take. But much of the responsibility for actually implementing the changes falls to states, so the Obama administration's top health official has been working to guide them." Many states say they are underprepared to implement aspects of the health law, especially when it comes to having the money to hire staff to implement health insurance exchanges slated to begin in 2014. Indeed, others are weighing their role as well. "Missouri will hold a ballot on Tuesday on whether to knock down the health care law by invalidating the requirement that most people buy insurance or pay a fine. Some other states are planning similar votes."

"Another contentious issue is Medicaid funding. Budget-challenged states want more flexibility to pare back spending on the federal-state program for the poor, but the law effectively prevents them from doing that. Ms. Sebelius's hands are mostly tied. Congress has repeatedly failed to pass a $24 billion funding extension states say they need to keep existing Medicaid eligibility rules" (Adamy, 8/1).

The Christian Science Monitor: HHS announced last week that each state could get as much as "$1 million in federal grants to set up the exchanges. The idea is that government creates the marketplace; the private sector competes." Some states, however, are moving on restricting private company access to the large pool of people who will be seeking insurance. "Two weeks ago, a panel appointed by New Mexico Gov. Bill Richardson recommended that the state establish an exchange that 'assumes an active role in driving market reforms and protecting consumers.' The panel's report goes on to explain: 'This could include restricting plans from the Exchange that would exceed specified premium growth levels or by requiring cost containment initiatives of plans participating in the Exchange.' … The panel proposes using the exchange as leverage with insurers 'to help control the cost of the health care system.' If that means not providing consumers information on plans that, in the state's eyes, aren't doing enough to keep costs down, the state seems ready to do that" (Belsie, 8/1).

The Hill: Few are satisfied with another provision of the health overhaul, the White House's mandated limits on abortion coverage. Regulations that restrict abortion coverage in the health law's high-risk pools have angered Planned Parenthood, which says it "strongly opposes" the restrictions. "The regulation limits abortion coverage in the federally funded pools, which cover people with pre-existing conditions, to cases of rape, incest or when the mother's life is in danger." Planned Parenthood says abortion coverage is needed for people with serious medical conditions where an abortion would be needed to avoid other medical complications in people with chronic conditions. In the meantime, the provision also did not please anti-abortion groups. "At the other end of the spectrum, the National Right to Life Committee cautions that the regulation raises concerns about the broader health care reform law" (Pecquet, 8/1).

The Associated Press: A provision of the health law that requires businesses to file tax forms for every vendor that sells them more than $600 in goods could become a "paperwork nightmare." The provision was designed "to prevent vendors from underreporting their income to the Internal Revenue Service. The government must think vendors are omitting a lot because the filing requirement is estimated to bring in $19 billion over the next decade. … The House rejected a bill Friday that would have repealed the provision. The two parties disagreed on how to make up the lost revenue." Republicans propose changing other parts of the health law to pay for it; Democrats want to raise taxes on international corporations and limit the use of special trusts to avoid gift taxes (Ohlemacher, 8/1).