State and the fate of health reform, ctd.
By Suzy Khimm
I wrote last week about how the fate of health reform depends on the states, given their starring role in carrying out major parts of the
Affordable Care Act. They'll be hugely responsible for setting up the new insurance exchanges -- which have to be running by 2014 -- and enforcing the beefed-up insurance regulations. But there are changes already underway that will give us an early preview of what's to come.
One of the pieces of reform that will take effect almost immediately are the high-risk pools for adults with preexisting conditions who have trouble getting insurance elsewhere. Each state has to set up a pool by July 1, or else the federal government will have to step in. The Wall Street Journal explains:
About 35 states currently operate their own high-risk pools. ... States that already have such pools can add a new pool; those that don't can start a risk-pool. States also can build on other existing programs to cover high-risk adults or contract with a so-called carrier of last resort to provide subsidized coverage. If a state chose to do nothing, HHS would carry out its own coverage program in the state.
The states' willingness and ability to set up these high-risk pools by the July 1 deadline will be an early indicator of how cooperative states governments will be in putting the law into effect. Some observers are already worried that the 90-day implementation is too short and that the $5 billion devoted to the project won't be enough to make premiums affordable, as the Journal notes. And I imagine that some reform-resistant states may be reluctant to set up these pools -- and will not be particularly happy when the federal government has to intervene. At the same time, there will certainly be states eager to become model examples of how reform can work. Will this first step broaden the gap between states that have already made "a lot more progress toward solving the problem" and states that are already behind the ball, as Matt Yglesias asks? Or will even anti-reform state governments prove willing to enact one of the most popular parts of the new health law, however begrudgingly? Either way, it will be worth watching what does and doesn't happen by July 1 and how HHS ends up dealing with the problems that could crop up -- particularly as these high-risk pools will be building blocks for the full insurance exchanges in each state.
Meanwhile, some states are already taking another piece of the Affordable Care Act into their own hands. The WonkRoom's Igor Volsky explains how state legislators are already taking advantage of a provision in the law that allows states to place additional abortion coverage restrictions on their future insurance exchanges:
The federal health care law prohibits public dollars from being used to finance abortions and requires insurers that choose to offer abortion coverage to collect a separate check from policy holders, but the law also gives states the option of banning private insurers from providing abortion coverage to women within the exchange. Tennessee is at least the second state to take advantage of this provision, advancing legislation that would eliminate abortion coverage from an exchange that does not even go into effect until 2014. The Tennessee House Commerce Committee passed the bill (HB 2681) on a voice vote last week....A Missouri Senate committee also approved a bill that would deny insurers the right to offer abortion coverage in any government exchange last month.
These are the kind of restrictions that Bart Stupak and his allies were trying to impose nationally during the reform debate. Though they didn't succeed, the law still leaves the door open for the states to act -- and I'd expect that pro-choice advocates are already working to re-engage their foes and pushing back on the state level.
— Suzy Khimm is a journalist who covered health-care reform at The
New Republic and is now a political reporter at Mother Jones.