In ways that are both obvious and not so obvious to consumers, states continue to pursue numerous anti-meth production policies. In this legislative session more than 100 bills were considered in 31 states to address the issue, in a variety of ways. While many of these policies still affect consumers directly at the point of sale, increasingly states are moving towards electronic reporting and recordkeeping by the retailer to lighten the impact on consumers.
Now, even with information identifying their largest health plans, states must contend with a lack of federal guidance addressing one of health care reform’s most politically charged issues: what benefits will be covered under the new system?
The 2012 legislative session is gearing up to be a busy one, particularly when it comes to fiscal issues. Federal stimulus dollars are drying up, revenue is down, and most states are increasingly strapped for cash. In an election year when these factors are sure to be politically polarizing, having access to the right lawmakers and staff can mean a world of difference and provide a key competitive advantage. During my time in the Florida State House I witnessed certain practices that are determinative of the success or failure of an advocate’s legislative agenda.
Over the course of the past month Stateside professionals interviewed contacts in all 50 states to get a sense of the top issues that will face lawmakers in the coming year.
Not according to Nancy Leppink, the Acting Administrator of the U.S. Labor Department’s Wage and Hour Division, who has taken to the official blog of the U.S. Department of Labor to respond to criticism of a ruling she issued this summer.
Since the enactment of the Affordable Care Act (ACA), state policy makers have known that they would be required to pick up the cost of any state mandates imposed on plans offered through a state health benefit exchange that exceeded the federal essential benefits. As a result, states have already introduced legislation and established commissions to review state mandated benefits in anticipation of the federal rules. With the release of the IOM recommendations, it appears that states may have much more control of which mandate benefits they will be able keep.
Two recent major pieces of federal legislation, the Patient Protection and Affordable Care Act (PPACA) and the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank), have created new law in policy areas previously directed by the states. For the first time, the federal government will be taking a lead role in insurance regulation and, accordingly, experienced state insurance regulators have made the jump to Washington, D.C. While these relatively new federal laws will certainly have a direct affect on state regulation, it is worth noting that the movement of state officials to the federal level can itself affect both state and federal policies.
The United States Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking July 11, setting out guidelines for the creation of State Health Benefit Exchanges under the Patient Protection and Affordable Care Act (PPACA) as well as a process for federal approval of those exchanges. Comments on the proposed rules will be due in late September 2011, fifteen months prior to the statutory January 1, 2013 deadline for federal approval of state exchanges. For states that have been waiting on these federal guidelines, this does not leave much time to authorize and establish a new regulatory entity to govern access to individual and small group health insurance.
As partisan positions have crystallized at the federal level, changes to the Patient Protection and Affordable Care Act (PPACA) through legislation look increasingly unlikely. While Congress and President Obama agreed to change the 1099 reporting mandate through legislation, future bi-partisan health care policy agreements will be rare. If American voters have developed a new respect for divided government, this could be the case well after full implementation of the PPACA in 2014. Accordingly, employers and states have been seeking, and getting, waivers from PPACA requirements based on executive authority already present under the law. While contested in some instances, PPACA health policy changes through waiver are in most ways a continuation of a long-standing state/federal relationship. They may also indicate how states will meet the design and time demands for implementation of state health benefit exchanges.
At the start of 2011 a number of factors set the table for an unprecedented and unpredictable legislative season. Twenty-one state legislative chambers changed majority control from Democrat to Republican, and Republicans picked up 11 Governorships. States were facing huge budget shortfalls. And no one knew what effect the Tea Party movement would have on getting things done in the legislatures. So looking back – how did these factors affect the productivity in the state legislative chambers?