States facing, making health law decisions that could all change post-election

Oct 23 2012

While next month's election will likely affect how states implement the health law's insurance exchange and Medicaid expansion provisions, state legislators are facing -- and making -- decisions on them now.

CQ HealthBeat: State Races Will Affect Medicaid, Exchanges
Beyond the impact next month's presidential elections will have on the nation's health care policy, the winners of gubernatorial contests will have an important role in implementing the federal overhaul. The outcomes of three tight state races in particular will determine the future of Medicaid and health insurance marketplaces in those states. If President Obama is re-elected, governors will have considerable sway over whether to expand Medicaid or operate their own state-run health insurance exchanges in 2014, among other policy choices. If former Massachusetts Gov. Mitt Romney becomes president, he is likely to try to stall or derail the 2010 health care law. However, unless the GOP wins a majority in the Senate, Romney would likely not be able to get an outright repeal of the law and governors would still face significant choices about health care in their states (Adams, 10/19).

The Philadelphia Inquirer: Christie Faces Decision On Health-Care Exchange
Gov. Christie must decide whether he wants the state or the federal government to manage a website that will compare the price of health-benefit plans in New Jersey, an element of President Obama's health care overhaul. A bill that establishes basic parameters for the online resource, known as a health-care exchange, if run by the state received final approval Thursday from the Assembly in a 44-33 vote with two abstentions. The measure was passed by the Senate earlier this month (Farrell, 10/19).

Stateline: Tennessee Plan Would Help Medicaid Families Keep Health Coverage
When the national health law takes effect on January 1, 2014, some 30 million uninsured people will be able to sign up for subsidized health insurance for the first time. Many will become eligible for Medicaid and others will qualify for federal tax credits. As challenging as that initial process is expected to be for consumers and state administrators, it won't end there. As people's incomes shift, nearly a third of those who sign up for Medicaid in 2014 will become ineligible for the program by the end of the year, according to a study by The Urban Institute. Among those who use federal tax subsidies to buy insurance through a health insurance exchange, more than half will lose their eligibility within a year (Vestal, 10/22).

Georgia Health News: Experts: Medicaid Expansion Has A Good Track Record
Medicaid expansions undertaken by New York, Arizona, Maine and Oregon may give clues as to how a similar decision would play out in Georgia and other states under federal health reform, two leading researchers said Friday at an Atlanta forum. The decision whether to expand Medicaid looms as hugely important for the states, assuming that the 2010 reform law remains intact after the upcoming elections. ... In New York, Arizona and Maine, each of which expanded Medicaid between 2000 and 2005, rates of uninsured residents dropped, access to care improved, and more people reported being in very good or excellent health, according to a recent Harvard study that compared these states to neighboring states without expansion (Miller, 10/19).

St. Louis Beacon: Proposition E Would Require Popular Or Legislative Approval For Insurance Exchange
Last year, in a remarkable shift away from gridlock in Jefferson City, normally scrappy House members set aside their differences and voted to lay the ground work for setting up an affordable insurance exchange in line with rules in the Affordable Care Act. … The House's first step toward setting up an exchange began to unravel in the Senate. Two GOP members, state Sens. Rob Schaaf of St. Joseph and Scott Rupp of Wentzville, eventually got legislative approval for what would become Proposition E on the November ballot. It would forbid the Nixon administration or any state agency to plan for an exchange unless the action is "authorized by a vote of the people or by the legislature" (Joiner, 10/19).