[SeMissourian.com] Fair ~ 35°F  
River stage: 12.41 ft. Falling
Tuesday, Jan. 27, 2015

Obama's health care overhaul turns into a sprint

Thursday, November 8, 2012

(Photo)
FILE - In this March 23, 2010, file photo, President Barack Obama reaches for a pen to sign the health care bill in the East Room of the White House in Washington. Obama's re-election has guaranteed the survival of his health care law. Now the administration is in a sprint to the finish line to put it into place. In just 11 months, millions of uninsured people can start signing up for coverage. But there are hurdles in the way. Republican governors will have to decide whether they can join the team and help carry out what they've dismissed as "Obamacare." And the administration could stumble under the sheer strain of implementing the complex legislation, or get tripped up in budget talks with Congress.
(AP Photo/Charles Dharapak, File)
WASHINGTON (AP) -- The long slog has turned into a sprint. President Barack Obama's health care law survived the Supreme Court and the election; now the uninsured can sign up for coverage in about 11 months.

Even the government's top-ranking Republican, House Speaker John Boehner of Ohio, said Thursday that "Obamacare is the law of the land." But not all hurdles have been cleared.

Republican governors who opposed the law have to decide whether it's better for their states to now help carry it out. The administration could stumble carrying out the complex legislation, or get tripped up if budget talks with Congress lead to scaling back the plan.

"We are out of the political gamesmanship and into the reality," said Sandy Praeger, Kansas' Republican insurance commissioner. Next week, states have to say if they're committed to building the framework for delivering health insurance to millions.

"We are still going to be struggling through the politics, and there are important policy hurdles and logistical challenges," said Andrew Hyman of the nonpartisan Robert Wood Johnson Foundation, helping states carry out the law. "But we are on a very positive trajectory."

Instead of being dismantled by a Republican president and Congress, Obama's law is now on track to take its place alongside Medicare and Medicaid. The action starts right away.

A week from Friday, states must notify Washington if they'll be setting up new health insurance markets, called exchanges, in which millions of households and small businesses will shop for private coverage. The Health and Human Services Department will run the exchanges in states that aren't ready or willing.

Open enrollment for exchange plans is scheduled to start Oct. 1, 2013, and coverage will be effective Jan. 1, 2014.

In all, more than 30 million uninsured people are expected to gain coverage under the law. About half will get private insurance through the exchanges, with most receiving government help to pay premiums.

The rest, mainly low-income adults without children at home, will be covered through an expansion of Medicaid. While the federal government will pay virtually all the additional Medicaid costs, the Supreme Court gave states the leeway to opt out of the expansion. That adds to the uncertainty over how the law will be carried out.

A steadying force within the administration is likely to be HHS Secretary Kathleen Sebelius. The former Kansas governor has said she wants to stay until the law is fully enacted.

Governors will be the main counterparts to Sebelius, and Republicans are leading more than half the states.

Some, like Rick Perry of Texas and Rick Scott of Florida, have drawn a line against helping carry out Obama's law. In other states, voters have endorsed a hard stance. Missouri voters passed a ballot measure Tuesday that would prohibit establishment of a health insurance exchange unless the Legislature approves. State-level challenges to the federal law will continue to percolate.

Other GOP governors have been on the fence, awaiting the outcome of the election. All eyes will be on pragmatists like Chris Christie of New Jersey and Bob McDonnell of Virginia, whose states have done considerable planning to set up exchanges.

"Republican governors are at the center of the health care universe right now," said Michael Ramlet, health policy director at the American Action Forum, a conservative think tank. "They do not have a uniform position."

Virginia's McDonnell, in a rebuff to the administration, said in an interview published Thursday his state would not set up its own exchange, defaulting to a federally run one. McDonnell left open the possibility Virginia might later change course.

Some governors whose states aren't ready to run exchanges are considering the administration's fallback offer to run the new markets through a partnership.

"The real question for Republican governors is: 'Are you going to let the feds come into your state?'" Ramlet said. "The question for the Obama administration is whether they are going to have more flexibility."

Major regulations are due shortly covering such issues as exchange operations, benefits and protections for people with pre-existing health problems. That could signal the administration's willingness to compromise.

A check by The Associated Press found 17 states and the District of Columbia on track to setting up their own exchanges, while 10 have decided not to do so. The federal government could end up running the show in half or more of the states.

The states on track include California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington, and West Virginia.

Not setting up exchanges are Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, South Dakota, Texas, Virginia, and Wisconsin. Missouri and others are likely to join the list.

A recent AP poll found that 63 percent of Americans want states to run the exchanges, with 32 percent favoring federal control.

GOP governors are also seeking flexibility on expanding Medicaid. They are pressing Sebelius on whether the administration will approve partial, less costly expansions, more attractive to cash-pressed states.

As far as Medicaid, 11 states and the District of Columbia have indicated they will expand their programs, while six have said they will not. That leaves more than 30 undecided.

The states definitely expanding Medicaid include California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, New York, Vermont, and Washington. Those declining include Florida, Georgia, Louisiana, Mississippi, South Carolina, and Texas.

On Capitol Hill, Republicans say if a budget deal is going to include tax increases, it must also come with cuts to the health care law, or money-saving delays in its implementation.

While major changes can't be ruled out, they don't seem very likely to former Senate Majority Leader Tom Daschle, D-S.D., who is close to the administration.

"I think Democrats are increasingly emboldened about the health care act," Daschle said. "The president won re-election partly by defending it. There is a new dynamic around the health care effort."

Republican attempts to amend the law will continue, he said, but outright repeal is no longer a possibility.

Speaker Boehner seemed to second that in an interview with ABC News. Asked if he will make another attempt to fully repeal Obama's law, he responded, "Well, I think the election changes that."

But he added that parts of the health care law are very expensive and difficult to carry out and "everything has to be on the table" in budget negotiations. Later, spokesman Kevin Smith said that Boehner is "still committed to full repeal."


Fact Check
See inaccurate information in this story?


Comments
Note: The nature of the Internet makes it impractical for our staff to review every comment. If you feel that a comment is offensive, please Login or Create an account first, and then you will be able to flag a comment as objectionable. Please also note that those who post comments on semissourian.com may do so using a screen name, which may or may not reflect a website user's actual name. Readers should be careful not to assign comments to real people who may have names similar to screen names. Refrain from obscenity in your comments, and to keep discussions civil, don't say anything in a way your grandmother would be ashamed to read.

If certain parts of this law is not fixed it will put some businesses out that employ 50 or more people, they just cannot afford it and to be frank about it I don't how we the people are going to afford this massive bureaucracy.

-- Posted by swampeastmissouri on Thu, Nov 8, 2012, at 12:53 PM

Its going to be a long 4 years......

-- Posted by ugguggugg on Thu, Nov 8, 2012, at 2:22 PM

Affordable healthcare is not about health; it's about taxing everyone .

-- Posted by fightingindian on Thu, Nov 8, 2012, at 2:34 PM

Obamacare will completely wipe out every free market insurance company leaving the Federal Government as the sole payer (single payer) for healthcare (if you can find a doctor) and therefore the arbiter of dispensation of healthcare.

http://en.wikipedia.org/wiki/Single-paye...

Healthcare via the DMV paid for with premiums by the IRS.

No loss of freedom there, eh?

-- Posted by bbollmann on Thu, Nov 8, 2012, at 3:14 PM

This is a law we will all pay dearly for people if it is not amended in various sections of it. No doubt it will crush a lot of small businesses in it's current form this is the main reason why businesses are not hiring I don't know when the democrats are going to wake up to that. You have to have businesses before you have labor without businesses there will be no labor.

-- Posted by swampeastmissouri on Thu, Nov 8, 2012, at 4:10 PM

FightingIndian got it! To pay for more Medicaid people, taxes go up and the Fed prints more money!!

-- Posted by vietnamvet on Thu, Nov 8, 2012, at 5:01 PM

A lot of companies have said, they will pay the penalty and work their employees part time to avoid paying for insurance. I know people whose premiums are going up due to obama care and their letter stated that was why. Congress and obama don't care, they aren't paying for it. And people who can't afford it are going to get it paid for. Well, we will pay for it with higher taxes. I can't wait till my elderly relatives have to take the end of life classes.

-- Posted by scared of the future on Thu, Nov 8, 2012, at 5:36 PM

FROM each according to his MEANS, TO each according to his NEEDS! Thank you Comrade Obama.

-- Posted by thewonder on Thu, Nov 8, 2012, at 6:18 PM

It's the end of the world, schmoes. Health care? Horrors!

But...on the other hand...we are all Americans so if a majority voted for communism and socialism and fascism then I guess we accept that. Don't we? Because, I think I remember, we are a people who agree to be governed by majority vote? Right?

I mean if you are Americans.

-- Posted by Pythagoras on Thu, Nov 8, 2012, at 7:00 PM

Thank you President Obama!!! From every family with a child born with a genetic illness which is a pre-existing condition we thank you!!

-- Posted by Thinking for myself on Fri, Nov 9, 2012, at 11:34 AM


Respond to this story

Posting a comment requires free registration. If you already have an account on seMissourian.com or semoball.com, enter your username and password below. Otherwise, click here to register.

Username:

Password:  (Forgot your password?)

Your comments:
Please be respectful of others and try to stay on topic.


Related subjects