* Court ruling fails to erase doubts about implementation
* Health officials insist expansion will go forward
* Some states seem unlikely to budge as election looms
By David Morgan
WASHINGTON, June 29 (Reuters) – Now that the Supreme Court
has removed the main legal challenge to President Barack Obama’s
healthcare overhaul, policy experts question whether enough U.S.
states will be ready to implement the law when it takes full
effect in 2014.
Up to now, most states have avoided decisive action to build
the private insurance exchanges that would extend health
coverage to an additional 16 million Americans. Governors in
largely Republican states who oppose the entire law may still
refuse to act on the exchanges, requiring the federal government
to step in to operate them.
“We will be ready to ensure that every American has access
to affordable, high quality coverage on Jan. 1, 2014,” Mike
Hash, an official overseeing the exchanges effort at the U.S.
Department of Health and Human Services (HHS), said on Friday.
HHS says that 34 states have received $850 million in grants
to help plan and build the exchanges. Accepting the funds alone
does not signal significant progress, however.
According to the Kaiser Family Foundation, which tracks
healthcare issues, 17 states have made no significant progress
towards establishing an exchange or rejected the idea. Most of
them voted for Republican candidates during the 2008 elections
that brought Obama, a Democrat, to power.
Another 18 states are studying their options, leaving only
15 that have taken concrete steps to establish an exchange,
Kaiser said.
Some health experts fear that many of the states holding off
now will wait until the November elections in the hope
Republicans will win control of the White House or Congress and
repeal the law. Wisconsin Governor Rick Scott announced on
Thursday that he intended to do just that and other Republican
governors, including Sam Brownback of Kansas, expressed similar
views.
“If states really have the will to throw themselves into
this, there is time to set up an exchange. But if states are
going to wait for the election, then there isn’t time,” said
health economist Jonathan Gruber of the Massachusetts Institute
of Technology.
Former Obama administration officials acknowledge that two
years of political battles since the healthcare law was passed
in 2010 might hamper its full introduction.
“We have taken a two year diversion – which is one thing I’m
worried about … Everyone knows the law is going to be
implemented and the question now really is how well,” said Dr.
Ezekiel Emanuel, a former Obama healthcare adviser.
The Supreme Court ruling on Thursday upheld the core of the
law, but also allowed states to opt out of a planned expansion
of the Medicaid health program for the poor. That could also
jeopardize the law’s aim of enrolling another 16 million of the
most vulnerable Americans via Medicaid.
“Come this November, we are going to elect a new President
and a new Congress who will repeal and replace Obamacare. That’s
why we have refused to implement the Obamacare health exchange
or the Medicaid expansion,” Louisiana Governor Bobby Jindal said
in an emailed statement.
TIME OF THE ESSENCE
With the exchanges, timing is key. States must build
information technology systems capable of quickly evaluating
individual applicants to see if they are eligible for private
insurance or Medicaid, based on household income and other
factors. Only Massachusetts, which overhauled its health system
in 2006, has built one to date.
Gruber estimates that any given state could require a year
to build an exchange’s infrastructure. Those that wait until
after the November ballot could be ill-prepared by the autumn of
2013 when the federal government expects exchanges to offer open
enrollment.
The administration set a Nov. 16, 2012, deadline for states
to confirm they are building an exchange and maintains that will
leave the federal government enough time to step in and set one
up where needed.
But health experts say federal exchanges could create
service gaps by overlooking unique features in state health
system, while posing political risks to local officials by
providing benefits they denied to their citizens.
“Our objective is that every state will operate a
state-based exchange,” Hash said.
Joseph Antos, a health expert with the conservative American
Enterprise Institute, believes the administration could have
difficulty setting up federal exchanges because of the sheer
complexity of the task.
“They won’t be ready everywhere. And even the degree of
readiness – the idea that everything’s going to be smooth –
smooth is not the word you attach to implementation,” he said.
