Federal and State Officials Testify on ACA Implementation

Yesterday the House Energy and Commerce Subcommittee on Health held a hearing to review the status of the Obama Administration’s implementation of the Affordable Care Act’s exchanges and the expansion of Medicaid. During the hearing, the Committee heard from five State representatives and two key officials from the Administration regarding the critical questions surrounding implementation.  Chairman Fred Upton (R-MI) cited numerous requests from states to the Administration for guidance and answers to questions about the law. While informal guidance and rules (proposed and/or final) have been issued, unanswered questions remain. Three days before the hearing and less than a week before states must decide if they will run a state-based exchange, HHS released a FAQ memo answering thirty-nine frequently asked questions concerning Medicaid expansion, market reforms, and healthcare exchanges.

Regarding the Status of the ACA’s Health Exchanges, Gary Cohen, Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight (CCIIO) at the Centers for Medicare & Medicaid Services (CMS), said that despite delays in implementation, he was confident that the exchanges would be operational come January 2014. He also made it clear that states that decide that they are not currently in a position to operate their own exchanges can still take over after HHS gets a marketplace up and running. With respect to the Medicaid expansion, Cindy Mann, Deputy Administrator and Director for the Center for Medicaid and CHIP Services, reiterated that unlike the deadline for states to decide if they want to run their own exchanges, there is no deadline for states to tell CMS its plans on the Medicaid eligibility expansion.  Furthermore, they may choose to adopt the expansion at any time and if they adopt the expansion they may drop it at a later date if they so choose.

Bruce Greenstein, Secretary of the Louisiana Department of Health and Hospitals, testified to the challenges associated with implementation of the ACA, particularly as it relates to the Exchanges, and the Medicaid expansion. Louisiana has decided not to implement a state-based exchange, citing outstanding legal challenges, unrealistic timelines, and ongoing implementation barriers.

Dr. Joshua M. Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene testified that Maryland is working to tailor implementation of the Maryland Health Benefits Exchange and the Medicaid expansion to the unique environment in the state. His testimony also included detailed efforts the state has made to integrate the Exchange and Medicaid to create a seamless experience for their residents.

Andy Allison, Arkansas’ Medicaid Director, testified to the process that Arkansas has taken to expand the Medicaid program under the ACA, since Governor Mike Beebe offered his full support of expansion. The decision now rests with the Arkansas General Assembly, who will have to examine the challenges and opportunities that Medicaid expansion will present for the residents of Arkansas.

Whether the witnesses were optimistic or pessimistic regarding the future implementation of the ACA, everyone agreed on one thing: there is a lot of work ahead for federal and state governments if the implementation of the ACA is going to be successful. Despite the challenges that lie ahead, Representative Henry Waxman (D-CA) argued that the challenges alone should not delay or derail the implementation of the law.

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