Political, policy decisions swirl around state plans to implement health exchanges, Medicaid expansion

Even as the Department of Health and Human Services releases regulations offering guidance for the health law's online insurance marketplaces, these health exchanges -- as well as the overhaul's Medicaid expansion -- continue to be hot topics.

Politico: HHS Health Rules No Balm For States
Sure, the Obama administration is dumping piles of Affordable Care Act rules in everyone's laps now. The danger, though, is that the rules have been held up so long that the states' insurance commissioners -- even the ones that want to implement the law -- may have trouble making up for lost time. That's the word from the National Association of Insurance Commissioners meeting near Washington, D.C., last week, where commissioners from around the country told Politico that the Department of Health and Human Services has left large holes in its guidance for states building insurance exchanges -- online marketplaces for individuals to access subsidized insurance plans (Cheney and Millman, 12/3).

Kaiser Health News: Insurance Surcharges Will Fund Most Online Exchanges Created Under Health Law
Republican governors in Florida, Virginia, Texas and several other states say they're reluctant to build the online insurance markets required by the federal health law because they're worried about getting stuck with the bills (Galewitz, 12/3).

Bloomberg: Insurers To Pay Fees In States Rejecting U.S. Health Law
Health insurers who want to sell plans in states that refuse to create new U.S. health-care marketplaces will have to pay fees for the federal government to regulate them. Insurers will pay a fee of 3.5 percent of their premiums to sell plans in a federally run health exchange, the government said today in a regulatory filing. The exchanges are new marketplaces somewhat like online travel services where uninsured people will buy policies (Wayne, 11/30).

The Washington Post: State Lawmakers Gird For Battle Over Medicaid Expansion
As state legislatures prepare to meet in January, lawmakers across the country are girding for a battle over whether to sign on to the health care law's expansion of Medicaid (Aizenman, 12/2).

The Associated Press: States' Medicaid Decisions Scrutinized
Hundreds of billions of dollars and the well-being of millions of people will be at stake when more states consider in coming months whether to expand Medicaid under the federal health care overhaul. As legislatures look ahead to their 2013 sessions, the calculating and the lobbying have already begun. President Obama's law expands Medicaid, the federal-state health program for low-income people, but cost-wary states must decide whether to take the deal (12/3).

Medpage Today: State Docs Groups Hold Back On ACA Medicaid Changes
Most state physician groups have kept a low profile on their positions to expand Medicaid under the Affordable Care Act (ACA), even 6 months after the Supreme Court gave states an option to increase eligibility. … Unlike their hospital counterparts, professional doctor groups have been a bit slow to endorse the idea, even in states who have already said 'no' to the federal dollars. … Advocates of expansion have more ammunition as they approach state leaders in their decision to expand. A report released this week by the Urban Institute found states would save a combined $10 billion in the first 10 years of expansion. While spending would increase a modest $8 billion or 0.3 percent if all opted into the expansion, they would save $18 billion in uncompensated care, the analysis and state-by-state breakdown found (Pittman, 12/2).

The New York Times/Texas Tribune: Democrats Expect a Deal on Medicaid Despite Perry
Despite Gov. Rick Perry's firm opposition to a central tenet of federal health reform -- expanding the state's Medicaid program for those with low incomes -- Texas Democrats remain optimistic that the 2013 legislative session can yield a deal that brings in billions of additional federal dollars. It will be a tough sell: no Republican lawmaker has gone on record supporting the Medicaid expansion, which would add an estimated 1.8 million Texans to the joint state-federal health plan by 2022 (Aaronson, 12/1).

The Dallas Morning News: Dallas Interfaith Group Challenges Perry's Decision To Opt Out Of Medicaid Expansion
Gov. Rick Perry might have been surprised to hear his name invoked repeatedly during a recent gathering at Christ's Foundry United Methodist Mission. But the rollicking crowd that filled the northwest Dallas church was not praising the governor's leadership or even praying for his soul. Nearly 300 people crowded into the church to launch a petition drive challenging Perry's decision to opt out of a Medicaid expansion under President Barack Obama's Affordable Care Act (Jacobson, 12/2).

The Associated Press: State Health Plan Faces New Future
Considered by many as a prelude to today's federal health reform efforts, MinnesotaCare will celebrate its 20th anniversary this year -- and simultaneously see its demise, at least in its current form. Portions of the groundbreaking health care program don't comply with the Affordable Care Act. The future of MinnesotaCare will be one of several pressing health care issues facing legislators when they arrive at the Capitol in January (Crosby, 12/1).

Los Angeles Times: Health Care Law Will Have New California Legislature Scrambling
Facing a federal deadline, the Legislature must move quickly to pass measures to implement President Obama's health care law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law (Mishak, 12/2).

CQ HealthBeat: Fight Over The Health Care Law Spawns A Second Generation Of Lawsuits
The health care law is a gift that keeps on giving -- at least for lawyers. Despite a decision by the Supreme Court in June that upheld the law's individual mandate as a tax, opponents -- mostly led by conservative legal groups -- continue to mount challenges. Multiple lines of attack are represented in suits percolating in federal district and appellate courts, including one arguing that the law should be struck down because its language originated in the Senate rather than the House. "You can never get too much of the Affordable Care Act," said Randy Barnett, a professor at Georgetown University Law Center who also helped represent the National Federation of Independent Business in its challenge (Norman, 11/30).