State Governors Say They Need More Information on Exchanges
Several governors recently have criticized the Obama administration for not providing enough information about the health insurance exchanges created under the Affordable Care Act, saying there are too many unanswered questions for states to decide whether they will implement an exchange, Kaiser Health News' "Capsules," reports (Rao, "Capsules," Kaiser Health News, 11/19).
Under the ACA, states can operate their own exchange, partner with the federal government or let the government run an exchange for them.
Last week, HHS Secretary Kathleen Sebelius said states will be able to inform HHS of their decisions on Dec. 14, when they are requiredÂ to submit their blueprints for how they would operate their exchanges (California Healthline, 11/16).
Prior to Sebelius' announcement, Iowa Gov. Terry Branstad (R) sent the HHS secretary a letter, which included 50 questions about how the state-run exchanges would be established. Branstad wrote that the state continues "to struggle with too many unanswered questions on topics critically important to the final development of an exchange that meets the needs of Iowans, including the cost of building and operating an exchange" (Rao, "Capsules," Kaiser Health News, 11/19).
In addition, Utah Gov. Gary Herbert (R) on Monday also sent Sebelius a letter that included a list of "Top Ten Unanswered Questions About Federal Exchanges," such as the cost, whether state lawmakers will have a role in its operation and marketing strategies to inform consumers of their options. "In light of these and numerous other uncertainties, making any reasoned determination about the future of Utah's exchange or a federal exchange is virtually impossible," Herbert wrote (Dininny, AP/San Francisco Chronicle, 11/19).
Oklahoma Will Not Create State-Based Exchange
In related news, Oklahoma Gov. Mary Fallin (R) yesterday announced that her state will not create a state-based exchange, citing the potential costs to the state of operating an exchange, the AP/San Francisco Chronicle reports (Murphy, AP/San Francisco Chronicle, 11/19).
Fallin said, "It does not benefit Oklahoma taxpayers to actively support and fund a new government program that will ultimately be under control of the federal government." She added that a state-based exchange "is opposed by a clear majority of Oklahomans." Fallin also said that the state will not participate in the ACA's Medicaid expansion (Baker, The Hill's "Healthwatch," 11/19).
HHS Sees Role in Exchanges Expand
HHS will likely have a larger role in implementing health insurance exchanges than initially expected, as many states delayed announcing their plans until after the presidential election, Politico reports. So far, 17 states and the District of Columbia have said they will be ready to run their own exchanges by the Jan. 1, 2014, when the exchanges begin providing coverage. However, HHS likely will have a prominent role in the remaining states, including regulating insurance plans and developing a national IT infrastructure for state Medicaid systems to communicate with insurers. In some states, HHS could be in charge of certifying health plans offered on the exchanges, maintaining an appeals process and establishing a call center to answer consumer questions, according to Politico (Millman, Politico, 11/20).
Increased Workload Could Overwhelm IRS, Experts Say
Some experts are concerned that the Internal Revenue Service, which is tasked with implementing some of the ACA's most technical provisions, will be overwhelmed by the increased workload, Politico reports.
Under the ACA, the IRS is responsible for:
- Processing income-based insurance subsidies for individuals purchasing health insurance through health insurance exchanges;
- Collecting insurance subsidy overpayments;
- Incorporating more than 40 changes to the tax code, including collecting penalties for uninsured U.S. residents and raising the Medicare payroll tax for high-income beneficiaries;
- Issuing specific guidelines on ACA requirements for businesses, such as how to determine if plans offered to full-time employees are qualified; and
- Answering consumer questions about subsidized health coverage during their tax filing process.