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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

House Committee Probes Administration on Exchange Implementation and Medicaid Expansion

December 14, 2012—House Energy and Commerce Health Subcommittee Dec. 13 held a hearing to check-in on implementation of state health exchanges and the status of state’s expansion of Medicaid.  The focus of the hearing, titled, “State of Uncertainty: Implementation of PPACA's Exchanges and Medicaid Expansion,” was to “press the administration” for more details as the implementation deadline approaches.

Energy and Commerce Chair Fred Upton (R-Mich.) opened the hearing saying, “[B]asic questions remain unanswered. For example, no final rules detailing federal benefit mandates and actuarial value have been issued for health plans operating in the exchanges. Benefit requirements and cost-sharing rules for those newly eligible for Medicaid remain unresolved.” Chairman Upton noted the recent memo to states regarding state-based exchanges and Medicaid expansion, but continued, “This [memo] however only addressed a fraction of questions.”

Ranking Member Henry Waxman (D-Calif.) disagreed with the Chair, and said the Department of Health and Human Services (HHS) has “provided a constant stream of assistance and information to those taking steps to make this law their own.” He recognized that “[f]or some states, no information will ever be enough, but added, “Just this week…Nevada’s Republican Governor announced that Nevada will move forward with the Medicaid expansion.”

Cindy Mann, deputy administrator and director, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services (CMS), said, “CMS has been steadily working with States, issuing guidance and providing technical assistance, as well as building Exchange infrastructure and initiating the many information technology (IT) and business activities needed to assure readiness for Exchange open enrollment beginning October 1, 2013.”

With regard to Medicaid expansion for those adults between 100 and 133 percent of the federal poverty level, Mann said, “States have considerable flexibility regarding coverage for these individuals. For example, States can choose a benefit package benchmarked to a commercial package or design an equivalent package.  States also have significant cost-sharing flexibility for individuals above 100 percent of the Federal poverty level, and we intend to propose other cost-sharing changes that will modernize and update our rules.”

Bruce D. Greenstein, secretary, Louisiana Department of Health and Hospitals, said he believes the deadline for open enrollment in the exchanges seems unrealistic due to the timing of the release of guidelines and proposed rules from HHS. Mr. Dennis G. Smith, secretary, Wisconsin Department for Health Services, echoed Greenstein, saying, “there is indeed still a great deal of uncertainty across the country as we are now less than 10 months away from when health insurance exchanges and eligibility changes to Medicaid systems must be operational.  We believe the actual experience of many Americans will be different from the expectations that have been created.”

Contact;

Len Marquez
Director, Government Relations
Telephone: 202-862-6281
Email: lmarquez@aamc.org

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org