On health exchange, Neb. makes progress, Wis. and Texas mull next steps

A roundup of reports on what's happening on the ground in several states, where Republican governors have been opposed to implementing the health law's insurance exchanges.

Politico Pro: Neb. Exchange In Works Despite ACA Stance
Nebraska Republican Gov. Dave Heineman officially opposes implementing an exchange until after the Supreme Court rules on the health care reform suit, but his state's department of insurance appears to be doing the work necessary to have an exchange certified by HHS on time if the law is upheld. In fact, while the Heineman administration is rooting against the law, officials think a Nebraska-based exchange will be ready as soon as the Supreme Court issues its decision. In an email obtained by POLITICO, Nebraska Department of Insurance health analyst Michael Sciullo wrote to vendors on Monday to let them know the department would soon issue a request for information on "vendor progress ... for the continued planning and design of Nebraska's potential Health Insurance Exchange" (Feder, 2/27).

Politico Pro: Walker: We May Wind Up With An Exchange
Wisconsin Gov. Scott Walker, who last month rejected $38 million from the Obama administration to build a health insurance exchange, says his state may wind up doing its own exchange if "legal and political options are exhausted" by November. But if it does, it's likely to be as market-driven as possible -; with the state staying far in the background. Before returning the HHS funding, Walker announced late last year that Wisconsin would halt all exchange planning unless the Supreme Court upheld the Affordable Care Act. However, Walker told POLITICO on Sunday that he would wait until the November elections to figure out a path for a state-based exchange (Millman, 2/27).

Meanwhile, a Texas official says the state is ready to move forward in its implementation efforts -

The Texas Tribune: Health and Human Services Commission Health Leaders Say They're Ready for Federal Reforms
On Monday, state officials at a joint meeting of the House Insurance and Public Health committees told lawmakers that Texas is ready to move forward with President Obama's health care reform package next month, regardless of whether the U.S. Supreme Court strikes down parts or all of it. "It has been a balancing act trying to determine how much planning to do versus waiting for the outcome," Billy Millwee, the deputy commissioner of the Health and Human Services Commission, told the panel. ... "I don't think we've lost anything, given the unknown factors" (Tan, 2/27). 

Houston Chronicle: Texans With Health Insurance Expected To Reach 91 Percent 
The percentage of Texans with health insurance will increase to 91 percent - up from 74 percent today - after the national health care law takes effect in 2014, the state's Medicaid director told lawmakers Monday. ... An estimated 2.3 million Texans will still lack health insurance after the Affordable Care Act takes effect, partially because undocumented immigrants are not eligible for coverage, State Medicaid Director Billy Millwee told a joint meeting of the House Public Health and Insurance committees (Scharrer, 2/27).

And in other health law implementation news -  

Politico Pro: PCORI Told To Keep The Focus On Patients' Needs
Listen to the patients. That was the message of the daylong second stakeholder meeting of the Patient-Centered Research Outcomes Institute on Monday. But what the patients actually want, or need, depended entirely on who you asked. Hours of the afternoon were dedicated to hearing nearly 70 public comments from patients, providers, payers and advocates for a wide variety of diseases. The outpouring of comments just proved exactly how daunting a task the PCORI board has ahead: accelerate comparative effectiveness research, but in a way that doesn't leave it open to "rationing" charges (Nocera, 2/27).