Yesterday
the House Energy and Commerce Subcommittee on Health held a hearing to
review the status of the Obama Administration’s implementation of the
Affordable Care Act’s exchanges and the expansion of Medicaid. During
the hearing, the Committee heard from five State representatives and two
key officials from the Administration regarding the critical questions
surrounding implementation. Chairman Fred Upton (R-MI) cited numerous
requests from states to the Administration for guidance and answers to
questions about the law. While informal guidance and rules (proposed
and/or final) have been issued, unanswered questions remain. Three days
before the hearing and less than a week before states must decide if
they will run a state-based exchange, HHS released a
FAQ memo answering thirty-nine frequently asked questions concerning Medicaid expansion, market reforms, and healthcare exchanges.
Regarding
the Status of the ACA’s Health Exchanges, Gary Cohen, Deputy
Administrator and Director of the Center for Consumer Information and
Insurance Oversight (CCIIO) at the Centers for Medicare & Medicaid
Services (CMS), said that despite delays in implementation, he was
confident that the exchanges would be operational come January 2014. He
also made it clear that states that decide that they are not currently
in a position to operate their own exchanges can still take over after
HHS gets a marketplace up and running. With respect to the Medicaid
expansion, Cindy Mann, Deputy Administrator and Director for the Center
for Medicaid and CHIP Services, reiterated that unlike the deadline for
states to decide if they want to run their own exchanges, there is no
deadline for states to tell CMS its plans on the Medicaid eligibility
expansion. Furthermore, they may choose to adopt the expansion at any
time and if they adopt the expansion they may drop it at a later date if
they so choose.
Bruce
Greenstein, Secretary of the Louisiana Department of Health and
Hospitals, testified to the challenges associated with implementation of
the ACA, particularly as it relates to the Exchanges, and the Medicaid
expansion. Louisiana has decided not to implement a state-based
exchange, citing outstanding legal challenges, unrealistic timelines,
and ongoing implementation barriers.
Dr.
Joshua M. Sharfstein, Secretary of the Maryland Department of Health
and Mental Hygiene testified that Maryland is working to tailor
implementation of the Maryland Health Benefits Exchange and the Medicaid
expansion to the unique environment in the state. His testimony also
included detailed efforts the state has made to integrate the Exchange
and Medicaid to create a seamless experience for their residents.
Andy
Allison, Arkansas’ Medicaid Director, testified to the process that
Arkansas has taken to expand the Medicaid program under the ACA, since
Governor Mike Beebe offered his full support of expansion. The decision
now rests with the Arkansas General Assembly, who will have to examine
the challenges and opportunities that Medicaid expansion will present
for the residents of Arkansas.
Whether
the witnesses were optimistic or pessimistic regarding the future
implementation of the ACA, everyone agreed on one thing: there is a lot
of work ahead for federal and state governments if the implementation of
the ACA is going to be successful. Despite the challenges that lie
ahead, Representative Henry Waxman (D-CA) argued that the challenges
alone should not delay or derail the implementation of the law.
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