The Department of Health and Human Services is facing July 1 deadlines for creation of high-risk pools to help individuals who have been without health insurance for six months or longer and a new web portal to provide consumers with information about health insurance plans. Separately, debate continues on Capitol Hill about additional Medicaid funding for states.
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JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. Congressional wrangling over Medicaid funding and help for the unemployed continues and the Federal Government faces a July 1st deadline to implement certain provisions of health care reform. To discuss this and more, as always, Mary Agnes Carey, senior correspondent for Kaiser Health News, and Sarah Kliff from POLITICO. Welcome to you, Sarah, as well. Mary Agnes, begin where the Senate left things with Medicaid funding, additional Medicaid funding for the states at the end of last week and where does it go?
MARY AGNES CAREY: Well, Max Baucus, who is head of the Finance Committee, had introduced a different package, a scaled back package on Medicaid. He took about $8 billion out of it to get it down to about $15 billion, but they still can’t get consensus in the Senate to move it.
They pulled out the Medicare doc fix, separately of course, and passed that a while ago, but on the Medicaid money, it has still not been passed. There is still pressure from governors who are complaining we have got budgets that begin July 1st; we need this money or we are going to have to make cuts in other places. But Senator Reid, that’s Harry Reid, the majority leader, has pulled the bill back now because they just could not get it through.
JACKIE JUDD: And Sarah, you have ben talking to political leaders at the state level. As Mary Agnes suggested, some of the governors are up in arms, what are they saying to you?
SARAH KLIFF: They really care about this money. When we have spoken with governors, this is almost priority number one. It’s a bipartisan priority; you have letters from about 47 governors signed, saying extend this money, we need those funds. As Mary Agnes said, they are relying on these to keep the Medicaid programs running.
Pulse, over at POLITICO, we talked to Jennifer Granholm in Michigan last week - and I mean this is a state, high unemployment rate, really has been dealt a pretty difficult hand by the recession - and she has been talking about some kind of possible lobbying trip to D.C., having a bunch of governors come down here to say this money is something that is a big priority, this is something that really matters to us. So, you can expect to see them talking a lot about this and not letting up pressure on Congress.
JACKIE JUDD: And many of the states have already incorporated these expected funds into the coming year’s budget, so what are they saying will be the consequences if the dollars don’t come?
SARAH KLIFF: Right. They are saying scaled back Medicaid benefits. These are states that are dealing with really high unemployment rates. More people want to be on Medicaid and this is what FMAP was supposed to do - be a temporary relief for states as they were expanding their Medicaid roles - and now they are saying we are going to have to drop, talking in the hundreds of thousands of folks who are on Medicaid right now if they don’t get this extension.
JACKIE JUDD: There has also not been movement in the Senate on additional help for the unemployed, especially help for those who are on COBRA. Is that now a dead issue or will Harry Reid try to bring that back, too?
MARY AGNES CAREY: Well, Sherrod Brown is one of the proponents of this additional funding to help folks buy this health insurance, known as COBRA, to give them subsides. He says he is going to continue to push to get it passed. Of course, they cut it back to a six month package of aid for those folks who became unemployed and needed COBRA assistance as of June 1st, but I think it’s getting tougher and tougher.
We are talking about all of the pressure and the difficulty of passing additional Medicaid funding which has many Republican and Democratic Governors pushing for it. I think the window may be narrowing for this additional COBRA money. We will see how it plays out, but it is a pretty tough lift.
JACKIE JUDD: And describe the opposition, what is the opposition saying about the problems with this measure?
MARY AGNES CAREY: I think it is part of the bigger issue about spending and are we spending too much? Is the deficit too big? Do you really need to do this? It is part of that divide between the Democrats and the Republicans. Many Democrats argue this additional spending is needed.
Now some, the fiscal conservatives in the House, for example, the Blue Dogs, would say wait a minute and they have voiced some opposition to this. But it’s really that struggle over how much do you go further in the deficit spending? Will this really help? Is it time?
After we have provided, with the stimulus that passed last year, there was additional COBRA funding for 15 months, is it time to stop this now? I think that is really where the debate is.
JACKIE JUDD: Overnight, an institution within the institution of the Senate, Senator Robert Byrd of West Virginia, passed away after decades in the Senate. Does his death change at all the political equilibrium on the Hill in the Senate?
MARY AGNES CAREY: Well, since West Virginia has a Democratic Governor, a Democrat will be appointed to his spot. Of course, Senator Byrd will deeply be missed. He was just such a leader in the Senate and people revered him. He was a scholar of the Constitution, of Senate rules.
He used to give wonderful speeches on the floor that many reporters who would be in the Senate gathering, you would go out, you might have been filing but you would take a break to listen to Senator Byrd because you always learned something. Folks will miss him, but I don’t think it changes the political dynamic of the chamber.
JACKIE JUDD: Okay. July 4th, Sarah, the Department of Health and Human Services is under deadline to 1) create a new website for consumers to look at insurance plans, and 2) to create high risk pools. Why don’t you talk to us for a moment or two about those high risk pools.
SARAH KLIFF: Right. HHS has a very, very busy week this week.
JACKIE JUDD: Right, 24/7.
SARAH KLIFF: 24/7 over at their headquarters. They are launching a federal high risk pool, which part of the new health care reform law says that there is going to be this pool prior to when the exchange is started in 2014, where those who have been uninsured for at least six months can get insurance.
JACKIE JUDD: And those who have chronic conditions or serious medical problems.
SARAH KLIFF: Right, those with pre-existing who have suffered from uninsurance. So, right now the situation they are in, you have about 20 states who have said we are not going to run this. We are going to leave this to the Federal Government and HHS is going to launch that Federal pool on Thursday, July 1st. They’ve said applications should be available and ready then.
And then you have about 30 states that are going to run their own high risk pools, either through the government or contracting with a non-profit, and those states are kind of just in the final stages right now, hammering up those contracts. Talking to folks at HHS recently, it’s a real back and forth, tweaking these, just hoping to get all of these signed and they have a lot on their plates.
They are dealing with 30 separate state governments and for each one there are a few different things on these contracts, but it sounds like they are making steady progress. They are in constant contact with these states and aside from maybe a handful who are a little bit behind on the schedule, most states are going to have these programs established in some form by July 1st.
JACKIE JUDD: So when can consumers actually begin to enroll and then get coverage?
SARAH KLIFF: So, if you are in one of the 20 states that is doing the Federal pool, that is not running their own, they said applications should be available on July 1st and will actually be linked through that new website you just mentioned, healthcare.gov, that you should be able to get there through that web portal to sign up.
For the 30 states that are running their own pools, it is a little bit different. They are all on their own schedule summer, aiming to have applications out as soon as this week. Others are saying it is going to be longer. It might not be in some states until August or September as they are sorting out their internal things that need to happen in order to set up their pools, so it is a bit of a range.
JACKIE JUDD: And it’s a significant test for the reform law, how it will work, how the Federal Government turns things around fairly quickly. The bill was just signed into law in late March.
SARAH KLIFF: It was signed in March. All the health policy people we have been talking to say these are nearly impossible deadlines that they are working on, especially those in Massachusetts who have done this have really marveled at the speed at which HHS has moved, and with this web portal and this high risk pool, these are two very consumer friendly provisions. These are going to be very tangible links to the health reform law for a lot of folks, so you are right.
JACKIE JUDD: That some politicians hope they can tout for their November elections.
SARAH KLIFF: Right. So when they go home this summer, they are going to want to talk about this portal. They are going to want to talk about the people getting insurance through the high risk pools. So, it really is important that HHS get this right, make it easy to access, easy for people to understand, and so far they seem to be on a pretty good track.
JACKIE JUDD: Mary Agnes, tell us more about the website healthcare.gov - what is it intended to do in the immediate sense? And then as the months go on, what other kind of information will be included?
MARY AGNES CAREY: For this web portal initially, it will kind of look, as of July 1st, sort of like the yellow pages, just a listing of health insurance plans. Now, come October, they want to have more about cost and benefits, but the real wrangling here, and again this is another one of those windows in the implementation of health reform, is going to be what will be on this web portal.
Will you talk about data that, for example, the percent of claims that have been denied, or the percent of claims denials that have been appealed. Consumer groups say you have got to have this. It is critical. Insurers are pushing back and saying now wait a minute, that might be confusing to consumers.
But as you see the implementation of whether it’s the web portal for this, or the high risk pool that we are talking about, all these steps along the way you can expect a vigorous fight by all the interested parties to shape it to make it look the best for them.
JACKIE JUDD: And what are the firm deadlines as we move out? July 1st of course is when it goes live, and then in the fall, incrementally does the additional information get posted?
MARY AGNES CAREY: I think they are aiming for early October for that, but I think that as we are seeing, we are talking about for example the high risk pool, that was supposed to be 90 days after the bill’s enactment, well there is again what they passed in the law and then the reality, the mechanics like you are talking about, working with all these different states.
The Federal Government trying to set up contracts in states where the states don’t want a high risk pool, there may be some movement with that, but they are trying to stay as close to these deadlines as they can.
JACKIE JUDD: Okay, thank you both, Sarah Kliff of POLITICO, and Mary Agnes Carey of Kaiser Health News. Thank you for joining us. I’m Jackie Judd and this has been Health on the Hill.