Health care law and battleground states

By Lindsey Boerma Topics Domestic Issues ,Campaign 2012 (Credit: CBS News) (CBS News) The Supreme Court's decision Thursday to uphold key provisions of the Affordable Care Act has thrown many state governments in flux, either scrambling to ramp up preparations for increased Medicaid coverage or risking control of their insurance marketplace by banking on a new White House resident this November.

Governors Scott Walker, R-Wis., and Bobby Jindal, R-La., for example, have made clear their intentions to pursue the latter, refusing to ready their states for the health care law's provisions that will take full effect in 2014. "Every governor's got two critical decisions to make," Jindal, who frequents vice presidential rumors, said Sunday on Meet the Press. "One is do we set up these exchanges; and, secondly, do we expand Medicaid? And no, in Louisiana, we're not doing either one of those things.

"I don't think it makes sense to do those," Jindal continued. "I think it makes more sense to do everything we can to elect [presumptive GOP nominee] Mitt Romney to repeal 'Obamacare.'"

A win by Romney - the former Massachusetts governor who penned what Democrats say was the blueprint of President Obama's individual mandate - could hinge on this election's battleground states. On CBS News' Face the Nation on Sunday, Walker - governor of a particularly hot swing state - expressed sentiment similar to Jindal's, promising to "wait" until Republicans have "put in place a new president, a new Senate majority, and then ultimately repeal the law."

But a Jan. 1, 2013 deadline that requires states to have their insurance exchanges certified by the federal government poses threat to governors and state legislatures that wait too long to prepare for enormous spikes in Medicaid enrollment; if the deadline isn't met, the federal government will take control of that state's exchanges.

From special legislative sessions to ramped-up exchange efforts, local reports from these battleground states suggest political motivations will make them the most obvious barometer of the health care law's reverberations come November.

COLORADO - It's "full speed ahead" for health insurance expansion, reads a Denver Post article, which predicts the court's ruling will "speed insurance expansions to nearly all Coloradans, while opponents regroup for future fights, state officials and health experts said. The state will redouble efforts to prepare for 2014's growth in Medicaid enrollment, and a consumer 'exchange' where other individuals should find affordable, uniform benefits, proponents said." 

FLORIDA - Gov. Rick Scott, R-Fla., needs time to decide how he'll deal with the court's ruling, the Tampa Bay Times reports. However, it reads, if "the state decides to move forward, lawmakers already have placed a constitutional amendment on the ballot that would prohibit individuals or employers from being forced to obtain health insurance or from being penalized for not doing so. The ballot initiative, which needs 60 percent support to pass, is unlikely to have any real impact, however, because federal law supersedes state law. But it could bring the state and federal governments back together in a courtroom, a battle that Senate President Mike Haridopolos welcomes."

IOWA- Republicans and Democrats in Iowa are trying to avoid having to call a special legislative session by finding a time and place to informally determine how to implement the newly upheld health care law, reports the Des Moines Register. "State Sen. Jack Hatch, D-Des Moines, said he and Iowa Gov. Terry Branstad's chief of staff Jeff Boeyink have talked about a summit with others interested in health care. It would hopefully take place in the next two to four weeks, organized by a neutral group such as a hospital, he said. The main topic: hash over details of a state health-insurance exchange."

NEVADA - Facing a possible $60 million price tag from increased Medicaid enrollment over the next two years, Republican Gov. Brian Sandoval may opt out of the law's expanded Medicaid options, the Nevada Appeal reports: "Sandoval's office said the state Health and Human Services Department expects an additional 49,000 Nevadans to enroll in Medicaid as a result of the mandate to have insurance. Those are individuals not currently in the program even though eligible. Sandoval said that would cost the state about $60 million over the next biennium."

NEW HAMPSHIRE - With regards to the Supreme Court's decision, "New Hampshire's congressional delegation is reacting largely along party lines," the Associated Press reports, "with Republicans vowing to amend the law and Democrats praising the decision." Democratic Gov. John Lynch said in a statement: "As a state, we have been preparing to implement the Affordable Care Act and will continue doing so in a way that best fits New Hampshire." 

NEW MEXICO - The Santa Fe New Mexican calls the state's post-health care ruling position "limbo," reasoning that "Medicaid has a major footprint in New Mexico. It covers one in four New Mexicans to the tune of just under $1 billion in state dollars, or 16 percent of the state budget. The federal government picks up most of New Mexico's Medicaid tab, which totals $3.8 billion... Gov. Susana Martinez's administration on Thursday was still digesting Thursday's ruling and couldn't say what it would decide to push for -- a full-scale expansion of Medicaid, as called for under the law, or something else."

NORTH CAROLINA - Citing the Jan. 1 exchange deadline, the Charlotte Observer reports that North Carolina "risks losing control of the health insurance marketplace it has to establish under the federal law the U.S. Supreme Court upheld Thursday if it hesitates to authorize it much longer." Democratic Gov. Bev Perdue's office "said only that the governor would review the ruling to determine how it might affect Medicaid, and that she had spoken to U.S. Secretary of Health and Human Services Kathleen Sebelius." 

OHIO - The Supreme Court's ruling gives Republican Gov. John Kasich "the choice of whether to open Ohio Medicaid to an additional 700,000 to 900,000 uninsured Ohioans," the Dayton Daily News reports, "but it is unclear if the state will go ahead with it. Ohio Medicaid, a state and federally funded health plan for disabled and low-income people, would see its enrollment balloon by as much as 40 percent -- 3.1 million enrollees, up from the current 2.2 million -- and costs would climb $5 billion a year, according to the governor's Office on Health Transformation." 

PENNSYLVANIA - Gov. Tom Corbett won't yet comment on whether Pennsylvania will choose to cover more people under Medicaid, but Senate Appropriations Chair Jake Corman expressed concern that "if the decision of whether to expand subsidized medical care for the poor is truly left to the states, then it becomes a budget issue, meaning lawmakers will have input," the Associated Press reports. 

VIRGINIA - Republican Gov. Bob McDonnell, another favorite among Romney-veepstakes speculators, wouldn't weigh in on the state's next move following the court's ruling, but instead "lashed out at Obama for imposing an 'unfunded mandate' on Virginia to the tune of $2.2 billion over a decade if the state grows its Medicaid base," the Virginia-Pilot reports.

WISCONSIN - "We're going to wait," Gov. Scott Walker told Face the Nation about his plan for the health care law. "We have said all along that there was a legal step, there's a political step, and then after each of those steps were exhausted we will see what the future holds. But very clearly the court pointed out that the law is upheld constitutionally but it also pointed out very clearly this is a massive tax increase." The Wisconsin State Journal reports that implementing the law in Wisconsin "could insure 340,000 of the state's 526,000 uninsured residents, while business groups said the law would increase costs and health care providers debated some of its implications."

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Should States Really Regulate Health Insurance?

(Photo credit: Wikipedia)

Health insurance companies must make money to stay viable. To make money, the insurance company sets premium rates according to risk. If the insurance company covers mostly healthy people, there is good chance money will be left over at the end of the day.

Setting health insurance premiums is a complex science. Factors such as previous illness, occupation, gender, and where you live cause significant variation in how much you will use your insurance.  If insurance companies had their ideal situation, they would cover only healthy, young male accountants and bankers.  Fortunately, insurance companies are regulated by the states, so there are restrictions in what factors they can use in setting insurance rates. However, states vary widely in how well they protect their constituents in insurance matters.

It is good to remember that many state insurance regulators come from a previous life of being (drum roll here) – insurance industry executives.  Or they work in regulation and may move to jobs in (another drum roll) – the insurance industry.  This also happens on the federal level – a perfect example is Steve Larsen, the recent head of Center for Consumer Information and Insurance Oversight at CMS. He will be taking a job with for-profit United Health Care.  Just as with FINRA’s attempt at oversight of independent financial advisors, are state insurance regulators another example of the fox watching the hen house?

I come from the standpoint we are all good people, and most of us want to do positive things. Frequently, we are blinded by the culture of our environment. The majority of people I have worked with in the insurance industry are wonderful souls, but the insurance culture has significant health issues (pun intended.) This causes great people to do not so great things, and as a result consumers get the short end in the insurance market.

Could the fact that insurance regulators are significantly intertwined with the insurance industry explain the lack of protection for consumers in many states?  Texas is a great example.  Here is an example from the Texas Department of Insurance web site:

“Insurance companies set their own premiums. TDI does not have the authority to regulate or approve health plan rates… In general, health plan rates are determined by…

Number of group plan participants. Group plans are usually less expensive than individual plans. As group size increases, administrative costs per plan member decline. Also, smaller groups and individuals tend to buy health coverage based on participants’ targeted needs, increasing the likelihood of claims. This type of custom tailoring is less likely as claims risk is distributed across a larger population.Claims experience. You can expect to pay more if you’ve filed claims in the past.Age. Older people can reasonably be expected to require more frequent, and more expensive, health care. Your premium will reflect your age or the ages of the members in your group plan.Gender. Young males typically incur lower medical costs than young females, particularly during childbearing years. This changes with age until medical costs for males begin to exceed those for females in the late 50s and early 60s. Plans with a large number of young females or older males generally have higher rates.Geography. Health costs vary by region due to differences in cost of living, medical practices, and the amount of medical competition in the area.Industry. If you are in an employer-sponsored plan, your rates may be affected by the nature of your profession. Industries with more dangerous jobs and a higher number of accidents will have higher medical claims costs than others. High employee turnover in some industries can also result in higher administrative costs for the insurance company.”

This sort of “protection” is exactly why Texas has the highest rate of uninsured people in the country.  This begs the question – Should insurance be regulated at a state or federal level? The Supreme Court is going to weigh in any day now.  I don’t know the answer. I do know that unhealthy people, women, the elderly, and those with dangerous jobs should think twice about moving to Texas. If state regulation rules, then I will encourage Kaiser Family Foundation to start a consumer friendly section of their web site that rates state insurance regulators. (By the way, a big shout out to KFF – they are one of the best resources on health care information you can find anywhere.  Their statehealthfacts.org site can help you pick apart where your state ranks in health care. I am applying for a job there – kidding!)

The good news – if the Affordable Care Act stands, insurance prices will be based on just four things.

Premium rating area – if you live in a high cost health area such as Boston, New York, or Miami, you will pay more for health insurance.Number of people covered – if there are three people in your family, your insurance will cost more than if only two people are covered. Duh.Age – older people will not pay more than three times what younger people pay.Tobacco use – tobacco users will pay up to 1.5 times the rate of non-tobacco users.  This makes absolute sense.  I wish they would have included obesity as a lifestyle factor, but that lobby was too large to get the law passed.

This simplification will help consumers, improve transparency in pricing, and allow us to move to Texas without fear.  It really is a great state in many ways.

Questions, comments, suggestions?  Post here, or reach me on Twitter @CarolynMcC or at Carolyn.mcclanahan@gmail.com.

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Health Insurance Rate Hikes in Nine States Deemed Excessive by HHS

Thu, Mar 22, 2012, 5:39 PM EDT - U.S. Markets closed

Sorry, I could not read the content fromt this page.

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Feds release health overhaul blueprint for states

WASHINGTON (AP) — Fifty million people in America lack health insurance and the law says most of them must soon be provided coverage. But how to deliver?

The Obama administration Monday finalized an ambitious blueprint for new state-based markets that will offer consumers one-stop shopping along the lines of amazon.com.

It may sound simple enough, but getting there will be like running an obstacle course. The rule comes just two weeks before the Supreme Court takes up a challenge to the constitutionality of the law in a case brought by states. Many governors and legislators are on the sidelines awaiting the outcome, even as time is running out to act.

Starting Jan. 1, 2014, new health insurance markets called "exchanges" must be up and running in every state, the linchpin of a grand plan to make health insurance accessible and affordable to those who now struggle to find and keep coverage. Individual consumers and small businesses will be able to shop online for competitively priced coverage, and many will receive government subsidies to help pay premiums.

"More competition will drive down costs and exchanges will give individuals and small businesses the same purchasing power big businesses have today," Health and Human Services Kathleen Sebelius said in a statement.

Experts say it's anybody's guess how the national rollout will go. If a state is not ready, the law requires the federal government to step in to run its exchange. But the Obama administration's request for $800 million to operate federal exchanges has gotten a frosty reception from congressional Republicans.

"At this point it's still an open question as to whether all the states will open up as of 1-1-2014," said Neil Trautwein of the National Retail Federation, a business group whose members will be heavily affected by the law.

Reaction on Monday to the 640-page rule was mixed. Consumer organizations, the insurance industry and some business groups gave it favorable or neutral reviews. Republican governors panned it.

The new markets are for individuals and small businesses buying plans. Most people who now have employer health insurance will not have to make changes. It's a design that works well in Massachusetts, where an exchange has been in place for several years.

Massachusetts achieved political consensus about its health care overhaul under former GOP Gov. Mitt Romney, who is now seeking his party's presidential nomination. That's far different from the enduring national divisions over President Barack Obama's law, even though it used Romney's as a foundation.

Setting up 50 state exchanges wouldn't be easy even if the federal overhaul enjoyed widespread support.

For things to go smoothly, state and federal officials must work together to verify private personal and financial details for millions of people, make sure that consumers are enrolled in the right health plan, and accurately calculate how much government aid, if any, each household is entitled to.

And with customer service the goal, consumers need to get answers in hours, not weeks.

Nearly 30 million people are eventually expected to get private health coverage through exchanges, about half of whom are currently uninsured.

Another group of uninsured people — as many as 16 million low-income Americans expected to qualify for Medicaid — could also enter the system through their exchanges.

States are moving in fits and starts to set up the new markets. Only 13 states and Washington, DC, have adopted a plan. Progress varies widely among other rest.

Under the law, most Americans will have a legal responsibility to carry health insurance, either through their job, a government program or by buying their own. Millions will receive financial assistance for their premiums.

Whether that amounts to an unconstitutional expansion of federal power is among the subjects of a showdown that begins March 26, when the Supreme Court is set to begin an unusual three days of arguments. A decision is expected by June.

Sebelius says she expects the court to uphold Obama's Affordable Care Act and thinks states will move quickly once the court has ruled.

States have until Jan. 1, 2013 to obtain federal approval for their exchanges. Among the rule's key elements:

— States can receive conditional federal approval for their exchanges if their plans are far along but not final by Jan. 1, 2013. States can operate exchanges in partnership with other states. The federal government will provide funding for different types of exchanges to allow for flexibility.

— The state exchanges themselves will determine the number and type of health plans offered to consumers, within broad standards set by the federal government. Plans will have to comply with marketing rules to ensure they are not trying to cherry-pick the healthiest customers in the state.

— Consumers must be able to apply online for coverage in their state exchanges. To reduce paperwork, exchanges will rely on existing computer databases to verify basic personal information and eligibility. However, some key details, such as whether the consumer is a legal resident of the U.S., may have to be verified by the government. And the IRS will have final say on tax credits.

— Exchanges must be able to pick from two federally approved methods for coordinating with the Medicaid program in their states.

— Exchanges must be able to use intermediaries called "navigators" to help educate consumers and small businesses about how the new system works.

— Exchanges must be financially self-sufficient by 2015, by charging fees to support their operations.

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Feds release health overhaul blueprint for states

WASHINGTON (AP) — Fifty million people in America lack health insurance and the law says most of them must soon be provided coverage. But how to deliver?

The Obama administration Monday finalized an ambitious blueprint for new state-based markets that will offer consumers one-stop shopping along the lines of amazon.com.

It may sound simple enough, but getting there will be like running an obstacle course. The rule comes just two weeks before the Supreme Court takes up a challenge to the constitutionality of the law in a case brought by states. Many governors and legislators are on the sidelines awaiting the outcome, even as time is running out to act.

Starting Jan. 1, 2014, new health insurance markets called "exchanges" must be up and running in every state, the linchpin of a grand plan to make health insurance accessible and affordable to those who now struggle to find and keep coverage. Individual consumers and small businesses will be able to shop online for competitively priced coverage, and many will receive government subsidies to help pay premiums.

"More competition will drive down costs and exchanges will give individuals and small businesses the same purchasing power big businesses have today," Health and Human Services Kathleen Sebelius said in a statement.

Experts say it's anybody's guess how the national rollout will go. If a state is not ready, the law requires the federal government to step in to run its exchange. But the Obama administration's request for $800 million to operate federal exchanges has gotten a frosty reception from congressional Republicans.

"At this point it's still an open question as to whether all the states will open up as of 1-1-2014," said Neil Trautwein of the National Retail Federation, a business group whose members will be heavily affected by the law.

Reaction on Monday to the 640-page rule was mixed. Consumer organizations, the insurance industry and some business groups gave it favorable or neutral reviews. Republican governors panned it.

The new markets are for individuals and small businesses buying plans. Most people who now have employer health insurance will not have to make changes. It's a design that works well in Massachusetts, where an exchange has been in place for several years.

Massachusetts achieved political consensus about its health care overhaul under former GOP Gov. Mitt Romney, who is now seeking his party's presidential nomination. That's far different from the enduring national divisions over President Barack Obama's law, even though it used Romney's as a foundation.

Setting up 50 state exchanges wouldn't be easy even if the federal overhaul enjoyed widespread support.

For things to go smoothly, state and federal officials must work together to verify private personal and financial details for millions of people, make sure that consumers are enrolled in the right health plan, and accurately calculate how much government aid, if any, each household is entitled to.

And with customer service the goal, consumers need to get answers in hours, not weeks.

Nearly 30 million people are eventually expected to get private health coverage through exchanges, about half of whom are currently uninsured.

Another group of uninsured people — as many as 16 million low-income Americans expected to qualify for Medicaid — could also enter the system through their exchanges.

States are moving in fits and starts to set up the new markets. Only 13 states and Washington, DC, have adopted a plan. Progress varies widely among other rest.

Under the law, most Americans will have a legal responsibility to carry health insurance, either through their job, a government program or by buying their own. Millions will receive financial assistance for their premiums.

Whether that amounts to an unconstitutional expansion of federal power is among the subjects of a showdown that begins March 26, when the Supreme Court is set to begin an unusual three days of arguments. A decision is expected by June.

Sebelius says she expects the court to uphold Obama's Affordable Care Act and thinks states will move quickly once the court has ruled.

States have until Jan. 1, 2013 to obtain federal approval for their exchanges. Among the rule's key elements:

— States can receive conditional federal approval for their exchanges if their plans are far along but not final by Jan. 1, 2013. States can operate exchanges in partnership with other states. The federal government will provide funding for different types of exchanges to allow for flexibility.

— The state exchanges themselves will determine the number and type of health plans offered to consumers, within broad standards set by the federal government. Plans will have to comply with marketing rules to ensure they are not trying to cherry-pick the healthiest customers in the state.

— Consumers must be able to apply online for coverage in their state exchanges. To reduce paperwork, exchanges will rely on existing computer databases to verify basic personal information and eligibility. However, some key details, such as whether the consumer is a legal resident of the U.S., may have to be verified by the government. And the IRS will have final say on tax credits.

— Exchanges must be able to pick from two federally approved methods for coordinating with the Medicaid program in their states.

— Exchanges must be able to use intermediaries called "navigators" to help educate consumers and small businesses about how the new system works.

— Exchanges must be financially self-sufficient by 2015, by charging fees to support their operations.

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Feds loan $638M for health co-ops in 8 states

HELENA, Mont. (AP) — Health care cooperatives that are being launched in eight states announced Tuesday they will receive a total of $638 million in loans from the Obama administration under the federal health insurance law.

The administration said the new nonprofit health insurers will be run by their customers and will be designed to offer coverage to individuals and small businesses. Supporters say the co-ops will keep pressure on private insurance companies for both price and coverage.

Critics, led by House Republicans who voted last year to repeal the health care law, immediately questioned the administration's decision. The House Ways and Means Committee called the loans a political reward to a friendly constituency.

Republicans noted that the recipient that received the largest loan — more than $340 million — was going to a group connected to the Freelancers Union, a nonprofit that serves independent contractors that are a growing segment of the workforce. Members are eligible for health insurance through a company owned by Freelancers.

The legislative panel questioned the organization's eligibility in a statement that said "it appears as though the Obama administration will stop at nothing to reward their political friends."

The administration said they determined the organizations getting the money are able to deliver the required services.

"Freelancers Union clearly met the legal standards under the statute and federal regulations," said Brian Cook, a Centers for Medicare and Medicaid Services spokesman. "They are not an insurer, they are a nonprofit union of independent workers, sole proprietors, and entrepreneurs who do not receive insurance through an employer."

Starting in 2014, millions of people who are currently uninsured will buy private coverage in new state markets under President Barack Obama's health care reform law. Tax-credit subsidies will help customers with the cost of the insurance.

The co-ops will compete in these state-run insurance exchanges, although co-op backers said they do not yet know the cost of premiums when the program will be formally unveiled in late 2013. Initially, they expect to compete for a small share of the overall health insurance market.

The new federal awards were announced for co-ops serving Montana, Iowa, Nebraska, New Jersey, New Mexico, New York, Oregon and Wisconsin. "It will be consumer-governed and will be responsive to consumer needs," said John Morrison, who is helping set up the cooperative in Montana.

Money from the loans will be given to the co-ops over time as they meet benchmarks for setting up claims processes, provider relationships, disease management and other cost-control efforts. Money from the loans will also be used to provide financial footing for the co-ops once they start fielding claims.

The federal government said it will be rolling out awards to co-ops in other states as more applications are processed.

The Freelancers Union said the loans will launch a new health care system that is "more affordable, more accessible, and more responsive to the needs of all workers." It expects to cover 200,000 people in New York, New Jersey and Oregon with five years of opening enrollment.

Some individuals and small business owners helping with the formation of the cooperatives said they believe the new operations will help reduce one of their most worrisome costs.

"Every year it's a challenge," said Tom Murphy, who employs eight people at Door Systems of Montana. "Every year for the last four, five or six years, it seems like we have had to decrease benefits to our employees due to rising costs in the health care system."

Montana congressman Denny Rehberg, a Republican trying to use his position as chairman of a House committee overseeing the new law to block its implementation, said he has been denied requests to see details behind the state cooperative's lengthy application.

"President Obama told us if we wanted to keep our existing health insurance, we could," Rehberg said in a statement. "So I don't think we ought to be using the hard-working taxpayers' own money to subsidize new government-approved health insurance companies that will displace existing programs that people like."

Morrison, a Democrat who used to be the Montana insurance commissioner, said that the volunteers who originally gathered to establish the Montana cooperative will hand over operations to a board of directors elected by the customers who eventually sign up for the service.

___

Associated Press writer Ricardo Alonso-Zaldivar contributed to this report from Washington, D.C.

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Health Overhaul Lags in Many States

WASHINGTON (AP) - Here's a reality check for President Barack Obama's health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress.

But an analysis by The Associated Press shows that states are moving in fits and starts. Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.

Such uneven progress could have real consequences.

If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama's law, called the Patient Protection and Affordable Care Act.

"There will be something there, but if it doesn't mesh with the state's culture and if the state is not really supporting it, that certainly won't help it succeed," said Urban Institute senior researcher Matthew Buettgens.

The 13 states that have adopted a plan are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it's not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured, 42 percent.

Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.

"It's not that we want something for free, but we want something we can afford," said Vicki McCuistion of Driftwood, Texas, who works two part-time jobs and is uninsured. With the nation's highest uninsured rate, her state has made little progress.

The Obama administration says McCuistion and others in the same predicament have nothing to fear. "The fact of states moving at different rates does not create disparities for a particular state's uninsured population," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.

That's because the law says that if a state isn't ready, the federal government will step in. Larsen insists the government will be ready, but it's not as easy as handing out insurance cards.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid. Many middle-class households will be eligible for tax credits to help pay premiums for private coverage. Separate exchanges must be created for small businesses.

"It's a very heavy lift," said California's health secretary, Diana Dooley, whose state was one of the first to approve a plan. "Coverage is certainly important, but it's not the only part. It is very complex."

California has nearly 7.5 million residents without coverage, more than half of the 12.7 million uninsured in the states with a plan. An estimated 2.9 million Californians would gain coverage, according to the Urban Institute's research, funded by the nonpartisan Robert Wood Johnson Foundation.

Democrats who wrote the overhaul law had hoped that most states would be willing partners, putting aside partisan differences to build the exchanges and help cover more than 30 million uninsured nationally. It's not turning out that way.

Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states are suing to overturn the law.

Time is running out for states, which must have their plans ready for a federal approval deadline of Jan. 1, 2013. Those not ready risk triggering the default requirement that Washington run their exchange.

Yet in states where Republican repudiation of the health care law has blocked exchanges, there's little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren't scheduled to meet past late spring.

The result if the law is upheld could be greater federal sway over health care in the states, the very outcome conservatives say they want to prevent.

"If you give states the opportunity to decide their own destiny, and some choose to ignore it for partisan reasons, they almost make the case against themselves for more federal intervention," said Sen. Ben Nelson, D-Neb.

A conservative, Nelson was on the winning side of a heated argument among Democrats over who should run exchanges, the feds or the states. Liberals lost their demand for a federal exchange, insulated

from state politics.

"It's pretty hard to take care of the states when they don't take care of themselves," said Nelson, who regrets that the concession he fought for has been dismissed by so many states.

The AP's analysis divided states into four broad groups: those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.

Thirteen states, plus the District of Columbia, have adopted a plan.

By contrast, in 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.

Four have made no significant progress. They are Arkansas, Florida, Louisiana and New Hampshire. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into immovable GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange, but is exploring a fallback option.

In the other 16 states, the outlook is unclear because of failure to advance legislation or paralyzing political disputes that often pit Republicans fervently trying to stop what they deride as "Obamacare" against fellow Republicans who are more pragmatic.

In Kansas, for example, Insurance Commissioner Sandy Praeger is pushing hard for a state exchange, but Gov. Sam Brownback returned a $31 million federal grant, saying the state would not act before the Supreme Court rules. Both officials are Republicans.

"It's just presidential politics," said Praeger, discussing the situation nationally. "It's less about whether exchanges make sense and more about trying to repeal the whole law." As a result, outlook is unclear for a state with 361,000 uninsured residents.

There is a bright spot for Obama and backers of the law.

An additional 17 states have made substantial progress, although that's no guarantee of success. Last week in Wisconsin, GOP Gov. Scott Walker abruptly halted planning and announced he will return $38 million in federal money.

The AP defined states making substantial progress as ones where governors or legislatures have made a significant commitment to set up exchanges. Another important factor was state acceptance of a federal exchange establishment grant.

That group accounts for just under one-third of the uninsured, about 16 million people.

It includes populous states such as New York, Illinois, North Carolina and New Jersey, which combined would add more than 3 million people to the insurance rolls.

Several are led by Republican governors, including Virginia and Indiana, which have declared their intent to establish insurance exchanges under certain conditions. Other states that have advanced under Republican governors include Arizona and New Mexico.

For uninsured people living in states that have done little, the situation is demoralizing.

Gov. Rick Perry's opposition to the law scuttled plans to advance an exchange bill in the Texas Legislature last year, when Perry was contemplating his presidential run. The Legislature doesn't meet this year, so the situation is unclear.

McCuistion and her husband, Dan, are among the nearly 6.7 million Texans who lack coverage. Dan is self-employed as the owner of a specialty tree service. Vicki works part time for two nonprofit organizations. The McCuistions have been uninsured throughout their 17-year marriage, although their three daughters now have coverage through the Children's Health Insurance Program. Dan McCuistion has been nursing a bad back for years, and it only seems to get worse.

"For me it almost feels like a ticking time bomb," his wife said.

Dan McCuistion says he doesn't believe Americans have a constitutional right to health care, but he would take advantage of affordable coverage if it was offered to him. He's exasperated with Perry and other Texas politicians. "They give a lot of rhetoric toward families, but their actions don't meet up with what they are saying," he said.

Perry's office says it's principle, not lack of compassion.

"Gov. Perry believes `Obamacare' is unconstitutional, misguided and unsustainable, and Texas, along with other states, is taking legal action to end this massive government overreach," said spokeswoman Lucy Nashed. "There are no plans to implement an exchange."

Online:

View the original article here

Health Overhaul Lags in Many States

WASHINGTON (AP) - Here's a reality check for President Barack Obama's health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress.

But an analysis by The Associated Press shows that states are moving in fits and starts. Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.

Such uneven progress could have real consequences.

If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama's law, called the Patient Protection and Affordable Care Act.

"There will be something there, but if it doesn't mesh with the state's culture and if the state is not really supporting it, that certainly won't help it succeed," said Urban Institute senior researcher Matthew Buettgens.

The 13 states that have adopted a plan are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it's not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured, 42 percent.

Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.

"It's not that we want something for free, but we want something we can afford," said Vicki McCuistion of Driftwood, Texas, who works two part-time jobs and is uninsured. With the nation's highest uninsured rate, her state has made little progress.

The Obama administration says McCuistion and others in the same predicament have nothing to fear. "The fact of states moving at different rates does not create disparities for a particular state's uninsured population," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.

That's because the law says that if a state isn't ready, the federal government will step in. Larsen insists the government will be ready, but it's not as easy as handing out insurance cards.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid. Many middle-class households will be eligible for tax credits to help pay premiums for private coverage. Separate exchanges must be created for small businesses.

"It's a very heavy lift," said California's health secretary, Diana Dooley, whose state was one of the first to approve a plan. "Coverage is certainly important, but it's not the only part. It is very complex."

California has nearly 7.5 million residents without coverage, more than half of the 12.7 million uninsured in the states with a plan. An estimated 2.9 million Californians would gain coverage, according to the Urban Institute's research, funded by the nonpartisan Robert Wood Johnson Foundation.

Democrats who wrote the overhaul law had hoped that most states would be willing partners, putting aside partisan differences to build the exchanges and help cover more than 30 million uninsured nationally. It's not turning out that way.

Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states are suing to overturn the law.

Time is running out for states, which must have their plans ready for a federal approval deadline of Jan. 1, 2013. Those not ready risk triggering the default requirement that Washington run their exchange.

Yet in states where Republican repudiation of the health care law has blocked exchanges, there's little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren't scheduled to meet past late spring.

The result if the law is upheld could be greater federal sway over health care in the states, the very outcome conservatives say they want to prevent.

"If you give states the opportunity to decide their own destiny, and some choose to ignore it for partisan reasons, they almost make the case against themselves for more federal intervention," said Sen. Ben Nelson, D-Neb.

A conservative, Nelson was on the winning side of a heated argument among Democrats over who should run exchanges, the feds or the states. Liberals lost their demand for a federal exchange, insulated

from state politics.

"It's pretty hard to take care of the states when they don't take care of themselves," said Nelson, who regrets that the concession he fought for has been dismissed by so many states.

The AP's analysis divided states into four broad groups: those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.

Thirteen states, plus the District of Columbia, have adopted a plan.

By contrast, in 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.

Four have made no significant progress. They are Arkansas, Florida, Louisiana and New Hampshire. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into immovable GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange, but is exploring a fallback option.

In the other 16 states, the outlook is unclear because of failure to advance legislation or paralyzing political disputes that often pit Republicans fervently trying to stop what they deride as "Obamacare" against fellow Republicans who are more pragmatic.

In Kansas, for example, Insurance Commissioner Sandy Praeger is pushing hard for a state exchange, but Gov. Sam Brownback returned a $31 million federal grant, saying the state would not act before the Supreme Court rules. Both officials are Republicans.

"It's just presidential politics," said Praeger, discussing the situation nationally. "It's less about whether exchanges make sense and more about trying to repeal the whole law." As a result, outlook is unclear for a state with 361,000 uninsured residents.

There is a bright spot for Obama and backers of the law.

An additional 17 states have made substantial progress, although that's no guarantee of success. Last week in Wisconsin, GOP Gov. Scott Walker abruptly halted planning and announced he will return $38 million in federal money.

The AP defined states making substantial progress as ones where governors or legislatures have made a significant commitment to set up exchanges. Another important factor was state acceptance of a federal exchange establishment grant.

That group accounts for just under one-third of the uninsured, about 16 million people.

It includes populous states such as New York, Illinois, North Carolina and New Jersey, which combined would add more than 3 million people to the insurance rolls.

Several are led by Republican governors, including Virginia and Indiana, which have declared their intent to establish insurance exchanges under certain conditions. Other states that have advanced under Republican governors include Arizona and New Mexico.

For uninsured people living in states that have done little, the situation is demoralizing.

Gov. Rick Perry's opposition to the law scuttled plans to advance an exchange bill in the Texas Legislature last year, when Perry was contemplating his presidential run. The Legislature doesn't meet this year, so the situation is unclear.

McCuistion and her husband, Dan, are among the nearly 6.7 million Texans who lack coverage. Dan is self-employed as the owner of a specialty tree service. Vicki works part time for two nonprofit organizations. The McCuistions have been uninsured throughout their 17-year marriage, although their three daughters now have coverage through the Children's Health Insurance Program. Dan McCuistion has been nursing a bad back for years, and it only seems to get worse.

"For me it almost feels like a ticking time bomb," his wife said.

Dan McCuistion says he doesn't believe Americans have a constitutional right to health care, but he would take advantage of affordable coverage if it was offered to him. He's exasperated with Perry and other Texas politicians. "They give a lot of rhetoric toward families, but their actions don't meet up with what they are saying," he said.

Perry's office says it's principle, not lack of compassion.

"Gov. Perry believes `Obamacare' is unconstitutional, misguided and unsustainable, and Texas, along with other states, is taking legal action to end this massive government overreach," said spokeswoman Lucy Nashed. "There are no plans to implement an exchange."

Online:

View the original article here

Health overhaul lags in states

WASHINGTON (AP) -- Here's a reality check for President Barack Obama's health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress.

But an analysis by The Associated Press shows that states are moving in fits and starts. Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.

Such uneven progress could have real consequences.

If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama's law, called the Patient Protection and Affordable Care Act.

"There will be something there, but if it doesn't mesh with the state's culture and if the state is not really supporting it, that certainly won't help it succeed," said Urban Institute senior researcher Matthew Buettgens.

The 13 states that have adopted a plan are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it's not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured,

42 percent.

Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.

"It's not that we want something for free, but we want something we can afford," said Vicki McCuistion of Driftwood, Texas, who works two part-time jobs and is uninsured. With the nation's highest uninsured rate, her state has made little progress.

The Obama administration says McCuistion and others in the same predicament have nothing to fear. "The fact of states moving at different rates does not create disparities for a particular state's uninsured population," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.

That's because the law says that if a state isn't ready, the federal government will step in. Larsen insists the government will be ready, but it's not as easy as handing out insurance cards.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid. Many middle-class households will be eligible for tax credits to help pay premiums for private coverage. Separate exchanges must be created for small businesses.

"It's a very heavy lift," said California's health secretary, Diana Dooley, whose state was one of the first to approve a plan. "Coverage is certainly important, but it's not the only part. It is very complex."

California has nearly 7.5 million residents without coverage, more than half of the 12.7 million uninsured in the states with a plan. An estimated 2.9 million Californians would gain coverage, according to the Urban Institute's research, funded by the nonpartisan Robert Wood Johnson Foundation.

Democrats who wrote the overhaul law had hoped that most states would be willing partners, putting aside partisan differences to build the exchanges and help cover more than 30 million uninsured nationally. It's not turning out that way.

Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states are suing to overturn the law.

Time is running out for states, which must have their plans ready for a federal approval deadline of Jan. 1, 2013. Those not ready risk triggering the default requirement that Washington run their exchange.

Yet in states where Republican repudiation of the health care law has blocked exchanges, there's little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren't scheduled to meet past late spring.

The result if the law is upheld could be greater federal sway over health care in the states, the very outcome conservatives say they want to prevent.

"If you give states the opportunity to decide their own destiny, and some choose to ignore it for partisan reasons, they almost make the case against themselves for more federal intervention," said Sen. Ben Nelson, D-Neb.

A conservative, Nelson was on the winning side of a heated argument among Democrats over who should run exchanges, the feds or the states. Liberals lost their demand for a federal exchange, insulated from state politics.

"It's pretty hard to take care of the states when they don't take care of themselves," said Nelson, who regrets that the concession he fought for has been dismissed by so many states.

The AP's analysis divided states into four broad groups: those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.

Thirteen states, plus the District of Columbia, have adopted a plan.

By contrast, in 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.

Four have made no significant progress. They are Arkansas, Florida, Louisiana and New Hampshire. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into immovable GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange, but is exploring a fallback option.

In the other 16 states, the outlook is unclear because of failure to advance legislation or paralyzing political disputes that often pit Republicans fervently trying to stop what they deride as "Obamacare" against fellow Republicans who are more pragmatic.

In Kansas, for example, Insurance Commissioner Sandy Praeger is pushing hard for a state exchange, but Gov. Sam Brownback returned a $31 million federal grant, saying the state would not act before the Supreme Court rules. Both officials are Republicans.

"It's just presidential politics," said Praeger, discussing the situation nationally. "It's less about whether exchanges make sense and more about trying to repeal the whole law." As a result, outlook is unclear for a state with 361,000 uninsured residents.

There is a bright spot for Obama and backers of the law.

An additional 17 states have made substantial progress, although that's no guarantee of success. Last week in Wisconsin, GOP Gov. Scott Walker abruptly halted planning and announced he will return $38 million in federal money.

AP defined states making substantial progress as ones where governors or legislatures have made a significant commitment to set up exchanges. Another important factor was state acceptance of a federal exchange establishment grant.

That group accounts for just under one-third of the uninsured, about 16 million people.

It includes populous states such as New York, Illinois, North Carolina and New Jersey, which combined would add more than 3 million people to the insurance rolls.

Several are led by Republican governors, including Virginia and Indiana, which have declared their intent to establish insurance exchanges under certain conditions. Other states that have advanced under Republican governors include Arizona and New Mexico.

For uninsured people living in states that have done little, the situation is demoralizing.

Gov. Rick Perry's opposition to the law scuttled plans to advance an exchange bill in the Texas Legislature last year, when Perry was contemplating his presidential run. The Legislature doesn't meet this year, so the situation is unclear.

McCuistion and her husband, Dan, are among the nearly 6.7 million Texans who lack coverage. Dan is self-employed as the owner of a specialty tree service. Vicki works part time for two nonprofit organizations. The McCuistions have been uninsured throughout their 17-year marriage, although their three daughters now have coverage through the Children's Health Insurance Program. Dan McCuistion has been nursing a bad back for years, and it only seems to get worse.

"For me it almost feels like a ticking time bomb," his wife said.

Dan McCuistion says he doesn't believe Americans have a constitutional right to health care, but he would take advantage of affordable coverage if it was offered to him. He's exasperated with Perry and other Texas politicians. "They give a lot of rhetoric toward families, but their actions don't meet up with what they are saying," he said.

Perry's office says it's principle, not lack of compassion.

"Gov. Perry believes 'Obamacare' is unconstitutional, misguided and unsustainable, and Texas, along with other states, is taking legal action to end this massive government overreach," said spokeswoman Lucy Nashed. "There are no plans to implement an exchange."

------

Online:

AP interactive: http://hosted.ap.org/interactives/2011/healthcare

Urban Institute estimates: http://tinyurl.com/86py8nd

Center for Consumer Information and Insurance Oversight: http://cciio.cms.gov

View the original article here

Obama's health overhaul lags in many states

WASHINGTON (AP) — Here's a reality check for President Barack Obama's health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress.

But an analysis by The Associated Press shows that states are moving in fits and starts. Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.

Such uneven progress could have real consequences.

If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama's law, called the Patient Protection and Affordable Care Act.

"There will be something there, but if it doesn't mesh with the state's culture and if the state is not really supporting it, that certainly won't help it succeed," said Urban Institute senior researcher Matthew Buettgens.

The 13 states that have adopted a plan are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it's not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured, 42 percent.

Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.

"It's not that we want something for free, but we want something we can afford," said Vicki McCuistion of Driftwood, Texas, who works two part-time jobs and is uninsured. With the nation's highest uninsured rate, her state has made little progress.

The Obama administration says McCuistion and others in the same predicament have nothing to fear. "The fact of states moving at different rates does not create disparities for a particular state's uninsured population," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.

That's because the law says that if a state isn't ready, the federal government will step in. Larsen insists the government will be ready, but it's not as easy as handing out insurance cards.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid. Many middle-class households will be eligible for tax credits to help pay premiums for private coverage. Separate exchanges must be created for small businesses.

"It's a very heavy lift," said California's health secretary, Diana Dooley, whose state was one of the first to approve a plan. "Coverage is certainly important, but it's not the only part. It is very complex."

California has nearly 7.5 million residents without coverage, more than half of the 12.7 million uninsured in the states with a plan. An estimated 2.9 million Californians would gain coverage, according to the Urban Institute's research, funded by the nonpartisan Robert Wood Johnson Foundation.

Democrats who wrote the overhaul law had hoped that most states would be willing partners, putting aside partisan differences to build the exchanges and help cover more than 30 million uninsured nationally. It's not turning out that way.

Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states are suing to overturn the law.

Time is running out for states, which must have their plans ready for a federal approval deadline of Jan. 1, 2013. Those not ready risk triggering the default requirement that Washington run their exchange.

Yet in states where Republican repudiation of the health care law has blocked exchanges, there's little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren't scheduled to meet past late spring.

The result if the law is upheld could be greater federal sway over health care in the states, the very outcome conservatives say they want to prevent.

"If you give states the opportunity to decide their own destiny, and some choose to ignore it for partisan reasons, they almost make the case against themselves for more federal intervention," said Sen. Ben Nelson, D-Neb.

A conservative, Nelson was on the winning side of a heated argument among Democrats over who should run exchanges, the feds or the states. Liberals lost their demand for a federal exchange, insulated from state politics.

"It's pretty hard to take care of the states when they don't take care of themselves," said Nelson, who regrets that the concession he fought for has been dismissed by so many states.

The AP's analysis divided states into four broad groups: those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.

Thirteen states, plus the District of Columbia, have adopted a plan.

By contrast, in 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.

Four have made no significant progress. They are Arkansas, Florida, Louisiana and New Hampshire. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into immovable GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange, but is exploring a fallback option.

In the other 16 states, the outlook is unclear because of failure to advance legislation or paralyzing political disputes that often pit Republicans fervently trying to stop what they deride as "Obamacare" against fellow Republicans who are more pragmatic.

In Kansas, for example, Insurance Commissioner Sandy Praeger is pushing hard for a state exchange, but Gov. Sam Brownback returned a $31 million federal grant, saying the state would not act before the Supreme Court rules. Both officials are Republicans.

"It's just presidential politics," said Praeger, discussing the situation nationally. "It's less about whether exchanges make sense and more about trying to repeal the whole law." As a result, outlook is unclear for a state with 361,000 uninsured residents.

There is a bright spot for Obama and backers of the law.

An additional 17 states have made substantial progress, although that's no guarantee of success. Last week in Wisconsin, GOP Gov. Scott Walker abruptly halted planning and announced he will return $38 million in federal money.

The AP defined states making substantial progress as ones where governors or legislatures have made a significant commitment to set up exchanges. Another important factor was state acceptance of a federal exchange establishment grant.

That group accounts for just under one-third of the uninsured, about 16 million people.

It includes populous states such as New York, Illinois, North Carolina and New Jersey, which combined would add more than 3 million people to the insurance rolls.

Several are led by Republican governors, including Virginia and Indiana, which have declared their intent to establish insurance exchanges under certain conditions. Other states that have advanced under Republican governors include Arizona and New Mexico.

For uninsured people living in states that have done little, the situation is demoralizing.

Gov. Rick Perry's opposition to the law scuttled plans to advance an exchange bill in the Texas Legislature last year, when Perry was contemplating his presidential run. The Legislature doesn't meet this year, so the situation is unclear.

McCuistion and her husband, Dan, are among the nearly 6.7 million Texans who lack coverage. Dan is self-employed as the owner of a specialty tree service. Vicki works part time for two nonprofit organizations. The McCuistions have been uninsured throughout their 17-year marriage, although their three daughters now have coverage through the Children's Health Insurance Program. Dan McCuistion has been nursing a bad back for years, and it only seems to get worse.

"For me it almost feels like a ticking time bomb," his wife said.

Dan McCuistion says he doesn't believe Americans have a constitutional right to health care, but he would take advantage of affordable coverage if it was offered to him. He's exasperated with Perry and other Texas politicians. "They give a lot of rhetoric toward families, but their actions don't meet up with what they are saying," he said.

Perry's office says it's principle, not lack of compassion.

"Gov. Perry believes 'Obamacare' is unconstitutional, misguided and unsustainable, and Texas, along with other states, is taking legal action to end this massive government overreach," said spokeswoman Lucy Nashed. "There are no plans to implement an exchange."

___

Online:

AP interactive: http://hosted.ap.org/interactives/2011/healthcare

Urban Institute estimates: http://tinyurl.com/86py8nd

Center for Consumer Information and Insurance Oversight: http://cciio.cms.gov

View the original article here

Health care overhaul lags in states

WASHINGTON — Here’s a reality check for President Barack Obama’s health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they’re making steady progress.

But an analysis by The Associated Press shows that states are moving in fits and starts. Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.

Such uneven progress could have real consequences.

If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama’s law, called the Patient Protection and Affordable Care Act.

“There will be something there, but if it doesn’t mesh with the state’s culture and if the state is not really supporting it, that certainly won’t help it succeed,” said Urban Institute senior researcher Matthew Buettgens.

The 13 states that have adopted plans are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it’s not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured, 42 percent.

Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.

“It’s not that we want something for free, but we want something we can afford,” said Vicki McCuistion, of Driftwood, Texas, who works two part-time jobs and is uninsured. With the nation’s highest uninsured rate, her state has made little progress.

The Obama administration says McCuistion and others in the same predicament have nothing to fear. “The fact of states moving at different rates does not create disparities for a particular state’s uninsured population,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.

That’s because the law says that if a state isn’t ready, the federal government will step in. Larsen insists the government will be ready, but it’s not as easy as handing out insurance cards.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid. Many middle-class households will be eligible for tax credits to help pay premiums for private coverage. Separate exchanges must be created for small businesses.

“It’s a very heavy lift,” said California’s health secretary, Diana Dooley, whose state was one of the first to approve a plan. “Coverage is certainly important, but it’s not the only part. It is very complex.”

California has nearly 7.5 million residents without coverage, more than half of the 12.7 million uninsured in the states with a plan. An estimated 2.9 million Californians would gain coverage, according to the Urban Institute’s research, funded by the nonpartisan Robert Wood Johnson Foundation.

Democrats who wrote the overhaul law had hoped that most states would be willing partners, putting aside partisan differences to build the exchanges and help cover more than 30 million uninsured nationally. It’s not turning out that way.

Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states are suing to overturn the law.

Time is running out for states, which must have their plans ready for a federal approval deadline of Jan. 1, 2013. Those not ready risk triggering the default requirement that Washington run their exchange.

Yet in states where Republican repudiation of the health care law has blocked exchanges, there’s little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren’t scheduled to meet past late spring.

The result if the law is upheld could be greater federal sway over health care in the states, the very outcome conservatives say they want to prevent.

“If you give states the opportunity to decide their own destiny, and some choose to ignore it for partisan reasons, they almost make the case against themselves for more federal intervention,” said Sen. Ben Nelson, D-Neb.

A conservative, Nelson was on the winning side of a heated argument among Democrats over who should run exchanges, the feds or the states. Liberals lost their demand for a federal exchange, insulated from state politics.

“It’s pretty hard to take care of the states when they don’t take care of themselves,” said Nelson, who regrets that the concession he fought for has been dismissed by so many states.

The AP’s analysis divided states into four broad groups: those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.

Thirteen states, plus the District of Columbia, have adopted plans.

By contrast, in 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.

Four have made no significant progress. They are Arkansas, Florida, Louisiana and New Hampshire. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into immovable GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange, but is exploring a fallback option.

In the other 16 states, the outlook is unclear because of failure to advance legislation or paralyzing political disputes that often pit Republicans fervently trying to stop what they deride as “Obamacare” against fellow Republicans who are more pragmatic.

In Kansas, for example, Insurance Commissioner Sandy Praeger is pushing hard for a state exchange, but Gov. Sam Brownback returned a $31 million federal grant, saying the state would not act before the Supreme Court rules. Both officials are Republicans.

“It’s just presidential politics,” said Praeger, discussing the situation nationally. “It’s less about whether exchanges make sense and more about trying to repeal the whole law.” As a result, outlook is unclear for a state with 361,000 uninsured residents.

There is a bright spot for Obama and backers of the law.

An additional 17 states have made substantial progress, although that’s no guarantee of success. Last week in Wisconsin, GOP Gov. Scott Walker abruptly halted planning and announced he will return $38 million in federal money.

AP defined states making substantial progress as ones where governors or legislatures have made a significant commitment to set up exchanges. Another important factor was state acceptance of a federal exchange establishment grant.

That group accounts for just under one-third of the uninsured, about 16 million people.

It includes populous states such as New York, Illinois, North Carolina and New Jersey, which combined would add more than 3 million people to the insurance rolls.

Several are led by Republican governors, including Virginia and Indiana, which have declared their intent to establish insurance exchanges under certain conditions. Other states that have advanced under Republican governors include Arizona and New Mexico.

For uninsured people living in states that have done little, the situation is demoralizing.

Gov. Rick Perry’s opposition to the law scuttled plans to advance an exchange bill in the Texas Legislature last year, when Perry was contemplating his presidential run. The Legislature doesn’t meet this year, so the situation is unclear.

McCuistion and her husband, Dan, are among the nearly 6.7 million Texans who lack coverage. Dan is self-employed as the owner of a specialty tree service. Vicki works part time for two nonprofit organizations. The McCuistions have been uninsured throughout their 17-year marriage, although their three daughters now have coverage through the Children’s Health Insurance Program. Dan McCuistion has been nursing a bad back for years, and it only seems to get worse.

“For me it almost feels like a ticking time bomb,” his wife said.

Dan McCuistion says he doesn’t believe Americans have a constitutional right to health care, but he would take advantage of affordable coverage if it was offered to him. He’s exasperated with Perry and other Texas politicians. “They give a lot of rhetoric toward families, but their actions don’t meet up with what they are saying,” he said.

Perry’s office says it’s principle, not lack of compassion.

“Gov. Perry believes ‘Obamacare’ is unconstitutional, misguided and unsustainable, and Texas, along with other states, is taking legal action to end this massive government overreach,” said spokeswoman Lucy Nashed. “There are no plans to implement an exchange.”

View the original article here

AP IMPACT: Health overhaul lags in states

WASHINGTON (AP) — Here's a reality check for President Barack Obama's health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress.

But an analysis by The Associated Press shows that states are moving in fits and starts. Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.

Such uneven progress could have real consequences.

If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama's law, called the Patient Protection and Affordable Care Act.

"There will be something there, but if it doesn't mesh with the state's culture and if the state is not really supporting it, that certainly won't help it succeed," said Urban Institute senior researcher Matthew Buettgens.

The 13 states that have adopted a plan are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it's not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured, 42 percent.

Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.

"It's not that we want something for free, but we want something we can afford," said Vicki McCuistion of Driftwood, Texas, who works two part-time jobs and is uninsured. With the nation's highest uninsured rate, her state has made little progress.

The Obama administration says McCuistion and others in the same predicament have nothing to fear. "The fact of states moving at different rates does not create disparities for a particular state's uninsured population," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.

That's because the law says that if a state isn't ready, the federal government will step in. Larsen insists the government will be ready, but it's not as easy as handing out insurance cards.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid. Many middle-class households will be eligible for tax credits to help pay premiums for private coverage. Separate exchanges must be created for small businesses.

"It's a very heavy lift," said California's health secretary, Diana Dooley, whose state was one of the first to approve a plan. "Coverage is certainly important, but it's not the only part. It is very complex."

California has nearly 7.5 million residents without coverage, more than half of the 12.7 million uninsured in the states with a plan. An estimated 2.9 million Californians would gain coverage, according to the Urban Institute's research, funded by the nonpartisan Robert Wood Johnson Foundation.

Democrats who wrote the overhaul law had hoped that most states would be willing partners, putting aside partisan differences to build the exchanges and help cover more than 30 million uninsured nationally. It's not turning out that way.

Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states are suing to overturn the law.

Time is running out for states, which must have their plans ready for a federal approval deadline of Jan. 1, 2013. Those not ready risk triggering the default requirement that Washington run their exchange.

Yet in states where Republican repudiation of the health care law has blocked exchanges, there's little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren't scheduled to meet past late spring.

The result if the law is upheld could be greater federal sway over health care in the states, the very outcome conservatives say they want to prevent.

"If you give states the opportunity to decide their own destiny, and some choose to ignore it for partisan reasons, they almost make the case against themselves for more federal intervention," said Sen. Ben Nelson, D-Neb.

A conservative, Nelson was on the winning side of a heated argument among Democrats over who should run exchanges, the feds or the states. Liberals lost their demand for a federal exchange, insulated from state politics.

"It's pretty hard to take care of the states when they don't take care of themselves," said Nelson, who regrets that the concession he fought for has been dismissed by so many states.

The AP's analysis divided states into four broad groups: those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.

Thirteen states, plus the District of Columbia, have adopted a plan.

By contrast, in 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.

Four have made no significant progress. They are Arkansas, Florida, Louisiana and New Hampshire. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into immovable GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange, but is exploring a fallback option.

In the other 16 states, the outlook is unclear because of failure to advance legislation or paralyzing political disputes that often pit Republicans fervently trying to stop what they deride as "Obamacare" against fellow Republicans who are more pragmatic.

In Kansas, for example, Insurance Commissioner Sandy Praeger is pushing hard for a state exchange, but Gov. Sam Brownback returned a $31 million federal grant, saying the state would not act before the Supreme Court rules. Both officials are Republicans.

"It's just presidential politics," said Praeger, discussing the situation nationally. "It's less about whether exchanges make sense and more about trying to repeal the whole law." As a result, outlook is unclear for a state with 361,000 uninsured residents.

There is a bright spot for Obama and backers of the law.

An additional 17 states have made substantial progress, although that's no guarantee of success. Last week in Wisconsin, GOP Gov. Scott Walker abruptly halted planning and announced he will return $38 million in federal money.

AP defined states making substantial progress as ones where governors or legislatures have made a significant commitment to set up exchanges. Another important factor was state acceptance of a federal exchange establishment grant.

That group accounts for just under one-third of the uninsured, about 16 million people.

It includes populous states such as New York, Illinois, North Carolina and New Jersey, which combined would add more than 3 million people to the insurance rolls.

Several are led by Republican governors, including Virginia and Indiana, which have declared their intent to establish insurance exchanges under certain conditions. Other states that have advanced under Republican governors include Arizona and New Mexico.

For uninsured people living in states that have done little, the situation is demoralizing.

Gov. Rick Perry's opposition to the law scuttled plans to advance an exchange bill in the Texas Legislature last year, when Perry was contemplating his presidential run. The Legislature doesn't meet this year, so the situation is unclear.

McCuistion and her husband, Dan, are among the nearly 6.7 million Texans who lack coverage. Dan is self-employed as the owner of a specialty tree service. Vicki works part time for two nonprofit organizations. The McCuistions have been uninsured throughout their 17-year marriage, although their three daughters now have coverage through the Children's Health Insurance Program. Dan McCuistion has been nursing a bad back for years, and it only seems to get worse.

"For me it almost feels like a ticking time bomb," his wife said.

Dan McCuistion says he doesn't believe Americans have a constitutional right to health care, but he would take advantage of affordable coverage if it was offered to him. He's exasperated with Perry and other Texas politicians. "They give a lot of rhetoric toward families, but their actions don't meet up with what they are saying," he said.

Perry's office says it's principle, not lack of compassion.

"Gov. Perry believes 'Obamacare' is unconstitutional, misguided and unsustainable, and Texas, along with other states, is taking legal action to end this massive government overreach," said spokeswoman Lucy Nashed. "There are no plans to implement an exchange."

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Online:

AP interactive: http://hosted.ap.org/interactives/2011/healthcare

Urban Institute estimates: http://tinyurl.com/86py8nd

Center for Consumer Information and Insurance Oversight: http://cciio.cms.gov

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