CQ HEALTHBEAT NEWS
April 20, 2012 – 12:44 p.m.
Sebelius: HHS Ready to Lend a Hand to States ‘When’ Health Law is Upheld
By Jane Norman, CQ HealthBeat Associate Editor
While Republican state leaders are declaring that they won’t implement the health care law pending a U.S. Supreme Court decision, top Health and Human Services officials insisted on Thursday they remain utterly confident the Obama administration’s landmark overhaul will be upheld.
In fact, HHS Secretary
“What we are anticipating when the court finds the law constitutional is that we may have a rush of people who say, ‘How fast can we get ready?’ ” Sebelius said following an appearance at a health care forum. “That’s part of the planning going on; what we can do to get states ready to go by 2014.” Under the health law, states must have their exchanges up and running by then.
Sebelius also said she is “confident” of the overhaul’s success in the high court but that HHS won’t be caught unprepared if the law (PL 111-148, PL 111-152) is partly or entirely struck down.
“In the event that there is a different ruling, we will be ready,” she said. “But at this point our energy is really focused on continuing to making sure people know about the benefits and take advantage of what’s out there.”
The exchanges will function as marketplaces for the purchase of individual and small group health insurance, often by people using subsidies. Under the law, the federal government is supposed to step in and operate exchanges in states that don’t set them up, though HHS is offering a partnership arrangement to states as well in which the federal government would share some exchange responsibilities with states.
The Republican View
Some GOP governors, such as Wisconsin’s
Some longtime observers of state politics think that some states won’t act on the law even if it is upheld and will wait until the November elections (See related story, CQ HealthBeat, March 23, 2012).
Inside-the-beltway groups such as the conservative American Legislative Exchange Council and the libertarian Cato Institute are telling Republicans to hold off on exchange creation.
“The most important front right now is to ensure that states do not create the health-insurance exchanges Obamacare needs in order to operate,” health expert Michael Cannon of Cato wrote on April 12. “Refusing to create exchanges is the most powerful thing states can do to take Obamacare down. Think of it as an insurance policy in case the Supreme Court whiffs.”
Sebelius said that “what we’re seeing is states in all forms of readiness” and that’s understandable. “We have some who are gung ho ahead, we have others looking at the so called partnership model,” she said. “We have some who have said we’re not doing anything until we get a clear decision. That was always anticipated.”
The court heard oral arguments on the law for three days in late March and a decision is expected by the end of the court term in June. Justices aggressively interrogated administration lawyers about the law’s individual mandate, raising questions among observers about whether they might indeed strike it down.
Sebelius: HHS Ready to Lend a Hand to States ‘When’ Health Law is Upheld
The forum, sponsored by the Atlantic magazine, also included a panel discussion in which Farzad Mostashari, national coordinator for health information technology, said repeatedly he’s not worried about the law’s prospects. “We are implementing the law,” he said. “We are not pausing. We are confident the Supreme Court will uphold the Affordable Care Act.”
No matter what happens, the government has to move toward new payment systems that reward providers based on quality and efficiency rather than the volume of care, he said. “I think it’s clear we need to pay for care differently,” he said.
But Timothy Ferris, medical director at Massachusetts General Physicians Organization, said that the uncertainty over the court’s direction is having an impact, putting providers in a difficult position because it’s hard to make an argument for investment if company executives are worried about a reversal.
Henry Aaron, a senior fellow in economic studies at the Brookings Institution, said that it seems to be a “distinct possibility” that the law will not survive intact. “Somebody quipped at the end of the hearing there were two kinds of people on the Affordable Care Act, those who were optimists the bill would be sustained in full and those who had been sitting in the hearing room,” he said.
Aaron said the law will work much better if it includes the requirement that all Americans have health insurance, but it will work without it. “That would put in Congress’ lap the challenge of what to do with the rest of it,” he said. Without the mandate, the cost of premiums will be higher and fewer people will be added to the ranks of the insured, and insurers will be pushing hard for help from Congress, he said.
Should the law be invalidated, that would be a “first order catastrophe” with reverberations for years to come, said Aaron. “Can you imagine any president, after two presidents struck out, taking on this issue in a major way again?” he asked.
Jane Norman can be reached at jnorman@cq.com