Los Angeles Times: Obama’s reelection cements his healthcare law

Republican state leaders must decide quickly whether to implement it or have the federal government do so. Obama also faces imminent challenges to carry out the legislation.


By Noam N. Levey, Washington Bureau
5:49 PM PST, November 8, 2012

WASHINGTON — President Obama’s victory all but assures that his landmark healthcare law and its guarantee of insurance coverage for nearly all Americans will be implemented, effectively putting an end to the Republican campaign to derail the law.

That outcome — which seemed almost unimaginable this spring when the Supreme Court considered whether the Affordable Care Act was constitutional — puts immediate pressure on many Republican state leaders who fought it. They must decide in days whether to implement it or have the federal government do it for them.

Tuesday’s results also present Obama with a new set of challenges as he tries to fulfill the promise of his signature legislative achievement, the biggest expansion of the social safety net since Medicare and Medicaid were created in 1965.

Federal and state officials nationwide must create systems to handle millions of new insurance customers. Key will be setting up insurance marketplaces, known as exchanges, in every state by next October. (California has established one, but most states have not.)

Under the law, millions of Americans should be able to get health insurance for the first time starting in 2014. Millions more who don’t get coverage through work should be able to buy a health plan that meets new basic standards.

“It’s all over but the shouting,” said Families USA Executive Director Ron Pollack, a consumer advocate and leading champion of the law. “What was very questionable at the start of the year has been settled. … The Affordable Care Act will be a permanent fixture of the American healthcare system.”

But Obama will face renewed pressure to scale back the law as Congress tries to rein in federal budget deficits.

The act authorizes more than $1 trillion in new federal spending over the next decade. Although that is offset with new taxes and other spending cuts, critics say the law’s program to provide insurance subsidies to households making up to four times the federal poverty level — or about $90,000 for a family of four — is overly generous.

At the same time, health insurance companies, hospitals, employers and other interest groups are gearing up lobbying campaigns to modify the law, parts of which threaten to push up healthcare costs.

Also unclear is how the administration will contend with GOP governors who continue to resist the law and may spurn hundreds of billions of federal dollars to provide insurance coverage.

Several states, including Texas, Florida and Louisiana, have indicated they will not open their Medicaid programs in 2014 to cover all low-income citizens. Most states — including those with Republican statehouses — are expected to expand Medicaid because of the federal money the law provides.

The president could face even more resistance to the law if insurance premiums and other medical costs continue to rise in coming years, undermining a pledge he made in pushing for reform.

“It will be full-speed ahead with implementation. But there could still be some rocky going,” said Dean Rosen, a Republican healthcare lobbyist and onetime aide to former Senate Majority Leader Bill Frist.

James Capretta, associate director of the White House Office of Management and Budget under President George W. Bush, said many conservatives would not stop contesting the law. “The fight over the size and scope of government will continue,” he said. “Giving up is not an option.”

Polls show the public is evenly divided over the legislation. Republicans remain strongly in favor of repeal. And with control of the House, GOP lawmakers could continue to push proposals to eliminate or roll back parts of the law.

Obama in the past has signaled willingness to modify the law. But he has flatly rejected any major retrenchments. As the presidential campaign drew to a close, Obama increasingly defended the law. The president was introduced at one of his final rallies by a father whose 8-year-old daughter got treatment for leukemia thanks to the law, an anecdote he repeated in his victory speech Tuesday night.

Administration officials also insist they will not delay the law, which will allow Americans who don’t get coverage through work to buy insurance on Internet-based marketplaces called exchanges. “Consumers in all 50 states will absolutely have access to an exchange come January of 2014,” said Department of Health and Human Services spokeswoman Erin Shields Britt.

Under the law, states have until Nov. 16 to tell the department whether they will set up an exchange, a complicated project requiring new data systems, regulations and bureaucracy.

Just 15 states, including California, Maryland and Connecticut, as well as the District of Columbia, have established an exchange, according to the nonpartisan Kaiser Family Foundation. More than a third of the states are expected to reject that option, forcing the federal government to step in.

There has been much hand-wringing among state officials and others over the slow process of writing regulations outlining how these federal exchanges will work. But several experts said it was highly likely the Obama administration would be ready to open exchanges next fall.

Heather Howard, who directs the State Health Reform Assistance Network at Princeton University, cited Washington’s recent experience creating the popular Medicare Part D prescription drug program.

More uncertain is what smaller modifications the Obama administration may agree to make.

Insurance companies have been warning that a new tax on insurers — scheduled for 2014 — will be passed on to consumers, further inflating healthcare costs. Many insurers also warn that regulations limiting how much more insurers can charge older consumers could mean much higher rates for young people.

Many hospitals, meanwhile, are worried they could be saddled with more uninsured patients as states with conservative leaders decline to extend Medicaid coverage.

And employers are stepping up warnings that the law’s mandate requiring them to provide health benefits to full-time employees may prompt some to shift more workers to part-time, depressing employment.

Adjusting the law has been all but impossible over the last 2 1/2 years as Republicans pledged to destroy the legislation, fueling Democratic resistance to acknowledging emerging problems.

Those political dynamics may shift in Obama’s second term as implementation becomes an accepted reality, said Neil Trautwein, vice president of the National Retail Federation, many of whose members have been ardent opponents of the law.

“What gives me hope now is that so long as the Affordable Care Act remains the law of the land, I think Republicans and Democrats alike will have an interest in preventing any harmful effects on the economy,” he said.

Los Angeles Times: California speeds revamp of health insurance market

With Obama victory, state officials move ahead with implementing healthcare changes under the Affordable Care Act and expand insurance coverage.


By Chad Terhune
November 7, 2012

With President Obama’s reelection lifting a potential roadblock, California officials are rushing to implement the federal healthcare law and revamp the insurance market for millions of Californians starting next fall.

Republican challenger Mitt Romney had vowed to overturn the Affordable Care Act, casting uncertainty over efforts in California to use billions of federal dollars to extend coverage to many of the state’s 7 million uninsured.

Wednesday, California officials disclosed plans to spend nearly $90 million next year on marketing and outreach to millions of consumers who may become eligible for premium subsidies and other assistance under the federal law starting in 2014.

“The election removes what was really the last distraction from focusing on the job, which is to get millions of Californians enrolled in health coverage,” said Peter Lee, executive director of the California Health Benefit Exchange, which was renamed Covered California last week.

California was the first state to establish an insurance exchange after Congress passed the Affordable Care Act in 2010, and more than 30 other states have sought federal help in enacting their own. But some Republican-led states resisted the healthcare expansion as the presidential campaign wore on, and now the federal government may step in to open exchanges in those states.

The California exchange aims to enroll about 2 million new people in Medi-Cal, the state’s Medicaid program for the poor and disabled, and help an additional 2 million Californians buy private coverage with federal subsidies.

State leaders and consumer advocates remain concerned about whether the exchange will attract enough initial enrollment, particularly among healthier consumers, to keep premiums affordable. “I think the exchange will be a tougher sell than originally thought,” said Steve Valentine, president of Camden Group, an El Segundo healthcare consulting firm.

Meanwhile, health insurers are scrambling to assemble networks of medical providers, negotiate rates and design various health plans that comply with new levels of standardized benefits in the exchange.

“There are lots of details to sort out, and we don’t have all that much time,” said Paul Markovich, president of Blue Shield of California.

State lawmakers also must resolve several insurance issues in a special session expected to convene in January. Open enrollment in this new state-run insurance market will start in October 2013.

Those policies take effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty.

To woo consumers, Lee said, the exchange plans to use a wide range of marketing methods, from grass-roots efforts through churches and schools to advertising on TV and radio, to educate California’s large and diverse population about the new healthcare options. Next week, the exchange’s board is expected to finalize its marketing and enrollment plans ahead of a Nov. 16 federal deadline.

With the election over, federal officials are also expected to issue more guidance to states on implementing the healthcare law.

Some industry experts have lobbied federal officials to phase in new rules that limit the difference in consumer premiums by age.

By some estimates, that change may raise rates for some younger consumers as much as 45% under the federal law. Older consumers could pay about 13% less.

Critics said this change may attract too many sicker policyholders and too few of the young, healthier customers, threatening the viability of the exchange if healthcare costs rise too fast.

Patrick Johnston, president of the California Assn. of Health Plans, warned that “the risk of rate shock is real.”

The exchange hasn’t taken a formal position on the age-rating issue, but Lee said he’s open to federal officials gradually implementing those requirements beyond 2014.

“We need to look at a whole range of options to moderate price increases,” he said.

The Sacramento Bee: VSP to add 400 jobs after favorable state ruling


By Dale Kasler
Published Wednesday, Oct. 31, 2012

Vision Service Plan isn’t going anywhere. In fact, a favorable decision by a state agency Tuesday prompted the Rancho Cordova insurer to green-light a plan to add 400 jobs in the area.
The state agreed to rewrite the rules governing California’s fledgling online insurance market, a crucial piece of President Barack Obama’s overhaul of the health care system.
The revision gives companies like VSP – which insure eye care only – much greater access to sell coverage in the online market. VSP and other eye-care insurers can now take aim at the full range of Californians who will buy coverage through the market, which begins operations in January 2014.
The agency overseeing the new market, the California Health Benefit Exchange, said in August that stand-alone vision insurers could sell coverage to small businesses but not individuals – the biggest slice of the market. As many as 2.4 million uninsured Californians are expected to buy coverage through the exchange, which will be called California Covered.
VSP, which employs 2,100 Sacramentans, hinted it might leave the state. A slew of government and business leaders, led by Senate President Pro Tem Darrell Steinberg, D-Sacramento, urged the agency to change its mind.
The agency’s governing board reversed course Tuesday, voting 5-0 to let VSP and its peers become full participants in the market.
Within minutes, VSP Chief Executive Rob Lynch told The Bee the company will hire 400 workers in the region. The hirings had been deferred until the controversy was settled.
“We’ll take the hold off the jobs,” Lynch said. The hiring includes 250 new workers at VSP’s optical lens-grinding facility near Highway 50.
Lynch added that the company wasn’t actually contemplating leaving the state. But if the exchange hadn’t changed its mind, he said VSP would have taken “a serious look” at directing all future expansions to other states.
Ohio, Texas and New York, where VSP has operations, have been courting the company, he said.
Several of VSP’s supporters argued that the exchange’s original decision made little business sense because many Californians buy vision coverage from stand-alone companies like VSP.
“We think this is good for consumers,” the exchange’s executive director, Peter Lee, said in urging the board to reverse course.
The board’s original decision was tied to the federal tax subsidies being offered to individuals who buy through the exchange.
Letting individuals buy vision insurance from one company – and the rest of their insurance from another company – would require splitting the subsidies between the policies. The exchange board originally said that was too complicated.