“That is, states must now accept a comprehensive reorganization of Medicaid or forfeit all federal Medicaid funding—even though the spending power is circumscribed to preserve a distinction between what is local and what is national. If Congress is allowed to attach conditions to spending that the states cannot refuse in order to achieve an objective it could not outright mandate, the local/national distinction that is so central to federalism will be erased.”
“Twenty-six states on Tuesday asked the Supreme Court to overturn the health care reform law’s mandatory state expansion of the Medicaid program, a sleeper issue in the health care reform lawsuit that could determine how much leverage the federal government has with the states on any issue.
The states, led by Florida, argue that the federal government can’t force them to expand the Medicaid program, which has operated as a partnership between the feds and the states, as part of the 2010 health reform law. They argue that the Medicaid expansion is possibly more coercive than the law’s individual mandate.”
“In an action with major implications for health reform in Michigan, the state House has voted to turn down — at least for now — nearly $10 million in federal funds to create a statewide health exchange by 2014 to sell more affordable, standardized health insurance to consumers and small businesses.”
“New Hampshire has a high percentage of Medicare Advantage enrollees. Last month, 7,600 of them received notices that their coverage was being cancelled. Obamacare and another federal law passed in 2008, the Medicare Improvement for Patients and Providers Act, are killing Medicare Advantage to steer senior citizens back into regular Medicare, which offers fewer choices and is more heavily controlled from Washington.
As a result, thousands of Granite State seniors are being forced to switch doctors because they have to switch coverage.”
“Before ObamaCare’s state-based high risk pool program—the pre-existing condition insurance plan (PCIP)—went into effect, critics (including me) warned that enrollment in the program would run high and that as a result the program would go over budget. In California, at least, it turns out that prediction was half wrong. Enrollment in the program is much lower than expected. But program administrators are now worried it might go over budget anyway.”
“State officials are pushing back hard against what they view as shortcomings in the healthcare reform law for fear they’ll be barraged with complaints when people have trouble affording insurance. Federal regulators are writing the rules governing key aspects of the law, including the guidelines to determine who’s eligible for subsidies to buy private insurance. Those benefits will be delivered through state-based exchanges, however, leaving state officials on the receiving end of angry phone calls if glitches in the law aren’t ironed out by 2014.”
“Some of the federal healthcare law’s requirements related to insurance exchanges threaten the autonomy of U.S. states, which need more support in establishing the marketplaces, state governors said in a letter released on Thursday. ‘The decision to implement health insurance exchanges requires a number of complex policy decisions amid aggressive timelines,’ wrote the National Governors Association in a letter to U.S. Health Secretary Kathleen Sebelius dated Nov. 2.”
“Two tiny health insurance companies are exiting Florida’s individual market because of Democrats’ health law, the state’s insurance department announced Thursday in an effort to bolster its request for a waiver. Florida has asked for a waiver from the medical loss ratio requirement that requires insurers to spend at least 80 percent of premiums on medical care or give customers rebates. Several consumer advocacy groups argued Thursday that the state doesn’t need such a waiver.”
“Des Moines-based American Enterprise Group announced Thursday that it will exit the individual major medical insurance market, making it the 13th company to pull out of some portion of Iowa’s health insurance business since June 2010. The move means 110 employees will lose their jobs over the next three years — 40 in Des Moines and 70 in Omaha. It also underscores the widespread anxiety among insurance companies over the raft of regulation resulting from the health care overhaul bill.”
“In the end, avoiding grants with significant policy strings attached, while important, is only part of the task for state lawmakers opposed to Obamacare. They should also be pursuing their own agenda of patient-centered, market-based reforms that will constitute the “replace” part of “repeal and replace.” Given that the political, judicial, and logistical impediments to implementing Obamacare are actually increasing over time, those alternatives might be needed sooner than anyone expected.”