Employer-based insurance, funding to states among future implementation issues

The Atlantic spoke with Andrew Webber, president and CEO of the National Business Coalition on Health, "a national, not-for-profit organization that represents public and private sector employers," who said: "There are a lot of different requirement issues [in the health reform law]. … To be brutally honest, do [employers] like a lot of new regulation? No, they're business people. But I like the delivery system reforms." Webber added, "Big picture, what worries me is the president said, 'If you like your current coverage, we won't touch it.' Individuals with jobs enjoy getting health insurance through their employer. But there is no question that with the new regulation, more employers are asking the question, 'Are we going to stay in the game?' Maybe we're moving to a system and people get a voucher and they find insurance on the exchanges. That worries me. … I think the tax subsidy provides some incentive from a pure economic sense to have more and more comprehensive health insurance. I think it probably makes sense that that issue be debated. But this is a voluntary employer based system, and I worry about consequences of that provision and other provisions, to the foundation of employer-based insurance" (Thompson, 11/10).

Orlando Sentinel: "A repeal bill almost certainly would die in the Senate or get vetoed by President Barack Obama, but it would set up a national debate leading into the 2012 presidential election. Some congressional Republicans — and Florida legislators — also hope to block spending needed to implement the law, such as enforcement by the Internal Revenue Service and funds to help states phase in some provisions. … One big question is whether most Floridians during the next two years will want to ditch, scale back or expand the new law. Public reaction, now almost evenly divided, could change once more provisions kick in." Nationwide polls and interviews in Florida "indicate the public is conflicted and confused about measures intended to make coverage affordable and accessible while also making it mandatory, starting in 2014"  (Gibson/LaMendola, 11/11).

Fresno Bee: California's efforts to implement a state-run health insurance exchange "could be vulnerable as House Republicans threaten to starve the federal health program of funding." Republican control in the House "'could make things very messy. Actually, it's already very messy,' said professor John Ellwood of the Goldman School of Public Policy at UC Berkeley, a former special assistant at the Congressional Budget Office. 'If something requires an appropriation' of federal funds, 'that's where the Republicans will attempt to starve it,' Ellwood said" (Calvan, 11/11).

CQ HealthBeat: "The range of challenges states are facing next year in their efforts to create health insurance exchanges, coupled with the changed political landscape, may lead a number of them to delay legislative action to create the new marketplaces until 2012, [Molly Voris], an official with the National Governors Association (NGA) Wednesday told insurance executives meeting here." States have until 2014 to set up insurance exchanges but because of their complicated nature and certification requirements, the Department of Health and Human Services (HHS) "has urged state officials" to act quickly.  Among the issues lawmakers and governors will face are "churning," the movement of Americans from Medicaid to subsidized exchanges and back, and how states will create information technology "sophisticated enough to handle complex tasks such as determining eligibility for coverage" (Reichard, 11/10).