Tue
Nov 13 2012
12:31 pm

States must decide by Friday if they will establish their own health insurance exchange or let the federal government run it. Gov. Haslam is waffling, according to this AP report. Haslam fails to mention that the state received more than $9 million in grants from the federal government to implement an exchange ($1 million for planning and $8,110,165 for implementation).

According to the AP article, Haslam also says "he is still awaiting details about the federal requirement for an exchange before determining his preferred path." The Dept. of Health and Human Services published a Request for Comments in the Federal Register on August 3, 2010. Initial Guidance to States on Exchanges was issued on November 18, 2010. A proposed rule for waivers was published in the Federal Register on March 14, 2011. Proposed rules for state exchanges were published July 15, 2011, and the deadline for comments was September 28, 2011. This info can be found at HealthCare.gov.

UPDATE: The most recent presentation from the state exchange task force (it's not clear exactly who's in charge of implementing the exchange) was March 13, 2012. Their recommendation was to "Continue to advocate for the overturning and/or repeal of the PPACA" and to delay implementation awaiting "clarity of 2012 events" (i.e. the election.)

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Treehouse's picture

They get three more weeks to decide

Barker's picture

deadline

They still must notify the feds of their intent by Friday.

From the link:
But Health and Human Services Secretary Kathleen Sebelius softened the deadline a bit late on Friday. "The deadline for a Declaration letter for a State-based exchange remains Friday, November 16, 2012," she wrote in a letter to governors. "However, today, in order to continue to provide you with appropriate technical support if you are pursuing a State-based exchange, HHS is extending the deadline for State-based Exchange Blueprint application submissions to Friday, December 14, 2012."

R. Neal's picture

So they have three weeks to

According to that article, the deadline for states to notify DHHS of their intent is still Friday. The extension is for states to file their exchange "blueprint" plan.

So they have three weeks to finish two years worth of homework. Republicans keep wanting to get in government office but then find out they have to actually work and stuff.

Congress did its part. DHHS did their part. The voters have done their part. Too bad the election didn't turn out like the state Republicans wanted, because now they have to do their part. Or do nothing and punt.

Average Guy's picture

"Or do nothing and punt."

Dooley moving to Nashville as part of the Governor's legal team?

Rachel's picture

Let's see: we don't like

Let's see: we don't like Obama and his stinking law so we'll refuse to set up an insurance exchange. And then the Feds will do it for us.

Oh, wait....

Quite a quandry they're in, isn't it?

metulj's picture

It's called "status quo."

It's called "status quo." Tennessee always has its hand out to the Feds and always will. I said it before: One of the reasons that so much nonsense comes out of Nashville is that so much of what the State of Tennessee does is simply administer programs paid for with Federal money. The legislature really has nothing else to do, but push "Don't say gay" bills and that crap. The governorship is as weak as light beer. Why bother?

Dave Prince's picture

Okay, so to dumb it down a

Okay, so to dumb it down a little, Haslam has until Friday to either submit TN's intent to set up a state exchange, and if he doesn't, TN is automatically enrolled in the federal program, right? And if the intent to self-run is made known on time, TN has three weeks to get a basic framework plan ready? What happens if that blueprint isn't ready in time? Are all the deadlines of the "have X ready or you're switched to the federal exchange" variety, or is there a point at which the state can postpone and waffle and hem and haw?

Andy Axel's picture

Their recommendation was to

Their recommendation was to "Continue to advocate for the overturning and/or repeal of the PPACA" and to delay implementation awaiting "clarity of 2012 events" (i.e. the election.)

There was also the NFIB Supreme Court decision.

My guess is that they really didn't have an alternate plan.

Lucinda Hood's picture

Self-Managed Disaster Waiting to Happen ...

I'm old enough that my memory does occasionally fog on some issues, but as I recall, we jumped head long into managing our own Medicaid program under a previous administration and managed to botch it thoroughly in relatively short order, causing numerous people to lose much needed coverage and so on.

What makes the Governor think we'd be any better at self-management now than we ever were?

Somebody's picture

(No subject)

Average Guy's picture

First line of original linked article

Republican Gov. Bill Haslam says Tennessee could design its own health insurance exchange required under Democratic President Barack Obama's health care law, but resistance in the GOP-controlled General Assembly may cause the state to hand that power off to the federal government

"Could" means they haven't. "Resistance" means they won't.

The feet dragging is just a ploy of the Governor to keep his further Right at bay.

Rachel's picture

I don't think it's a ploy. I

I don't think it's a ploy. I think that on this, as on the Medicaid expansion, Haslam will want to sign the state up. He's not a dumb guy, and not signing up is dumb.

That said, it really WILL be difficult to get the legislature to agree. You can draw your own conclusions as to what I think about their intelligence.

Up Goose Creek's picture

Preparation

Do we really want a state exchange?? Especially one that has been cobbled together in 3 weeks?

Maybe Haslam is doing the right thing like he did with the city pension. Pass it along to people who know what they are doing and have the time to deal with it.

metulj's picture

And I heard his named

And I heard his named seriously for the GOP 2016 ticket

bizgrrl's picture

Don't know if the GOP can

Don't know if the GOP can handle another GWB type of candidate/president.

Sylvia Woods's picture

Just a question.

Since the state already administers the Medicaid/TN Care program with Federal money,and the new Healthcare program is to accomodate everyone, does that mean that, if the Federal takes over setting up the healthcare program, it will take the money it is now sending to the state and add it to the Tennessee Federal healthcare program?

It would serve the state Legislature right if they no longer get to handle the current amount of Federal money they receive for the TN Care program.

Rachel's picture

Two different things are

Two different things are going on here: the insurance exchange and the Medicaid expansion. The feds will take over the insurance exchange if the state refuses to set one up. This is the decision the state has to make by Friday.

The state also has to decide whether to "opt-in" to the new Medicaid program. If they do, they get a bunch of additional $$ to cover a bunch of folks who aren't covered now (I believe the Feds cover 95% of the cost of for the first year and 90% for a good # of years thereafter). Also, there are provisions in the expansion that the hospitals want because it affects how much $$ they get.

If the state opts out of the Medicaid expansion (and I'm not sure when the deadline for that is), they just lose the additional $$$ (they keep the fed $$ they now have), do damage to the hospitals, and leave a bunch of folks w/o health insurance (but satisfy the Obama haters). This is why the expansion was originally written into the law as mandatory, but SCOTUS said there had to be an opt-out provision.

It's too late for me to look up all the details of this stuff, but this is the broad outline.

Somebody with more details than I've got at my fingertips please jump in.

R. Neal's picture

There is a relationship

There is a relationship between state Medicaid/CHIP programs and the health insurance exchanges. From what I understand, states are required to have a consolidated eligibility and enrollment process for Exchange Qualified Health Plans, Basic Health Plans, Medicaid and CHIP. Presumably this is intended to get enrollees in the right program.

Another issue involves people transitioning from one type of eligibility to another based on changes in income, marital status, household makeup, etc.

From what I've read, the PPACA envisioned that states would at least consider using their existing state Medicaid administrative infrastructure and provider relationships to implement exchanges, provide seamless transition from one program to another, monitor compliance and control fraud and abuse.

Here's a report outlining some of the issues.

It's not clear how the Supreme Court decision to allow states to opt out of Medicaid expansion affects the overall policy, or how a federal exchange would work for a state without expanded Medicaid coverage in regard to eligibility, etc.

Here's another interesting report on Maryland's blueprint for implementing exchanges.

In addition to making your head hurt, reading this stuff is a reminder that delivering social services is complicated business. It's probably more complicated than running a chain of truck stops, and above the pay grade of agency appointee buddies who donated a lot to the ET Foundation or the UT Skybox program.

It's also a reminder that all this complexity involving a hodgepodge of programs could be eliminated with single-payer Medicare for all.

Rachel's picture

In addition to making your

In addition to making your head hurt

That it does.

reading this stuff is a reminder that delivering social services is complicated business. It's probably more complicated than running a chain of truck stops, and above the pay grade of agency appointee buddies who donated a lot to the ET Foundation or the UT Skybox program.

I've seen this at all levels of govt. Somebody gets appointed and wants to change stuff just by waving his hand over it. Unfortunately, it's usually not that easy (not to say that change shouldn't happen, just that folks should recognize the difficulties involved and make sure that they have qualified folks working on it).

It's also a reminder that all this complexity involving a hodgepodge of programs could be eliminated with single-payer Medicare for all.

+1

R. Neal's picture

Also, where's ALEC's model

Also, where's ALEC's model legislation to help states implement exchanges? Oh, wait...

metulj's picture

I am sure Nashville is

I am sure Nashville is a-slobber because of this mighty policy statement from TrollTopia.

Tennessee is going to do what Tennessee always does: Let the Feds handle it for them. Rubio/Haslam 2016!

EricLykins's picture

Possibly in an effort to not

Possibly in an effort to not be a one-term wonder, FL Governor Rick Scott drops opposition to Obamacare

"The election is over and President Obama won," Scott said. "I'm responsible for the families of Florida ... If I can get to yes, I want to get to yes."

Rachel's picture

I think we're going to see a

I think we're going to see a lot of this. Posturing about Obamacare was great politics for the Rs when they thought Romnney might win, but now that it's a reality and involves cold, hard cash, it's another matter entirely. Legislators can afford to keep blustering. Governors can't.

EricLykins's picture

last Friday's deadline?

RGA: Seriously, ya'll. We're all in Vegas putting together our gameplan to "lead from the states."
Sebelius: letters of intent and applications by December 14

Reminder: ANY STATE CAN REPEAL AND REPLACE OBAMACARE IN 2014. Tennessee's Republican ubermajority can put up or shut up at any time with a plan of action, thanks to the Wyden amendment.

Really? Yes. You got an updated State Innovation Waivers memo back in February.

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