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Transcript: Health On The Hill – Early Implementation Challenges To Health Law

Obama administration officials have begun the process of implementing health care overhaul legislation the president signed into law last month. Early challenges including creating a high-risk health insurance pool within the next 90 days and writing regulations to allow parents to keep adult children on their health insurance policies until age 26.

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JACKIE JUDD: Good day. I’m Jackie Judd with Health on the Hill. Implementation of the new health care overhaul law is moving ahead while political opponents are still hoping to derail it. Mary Agnes Carey and Julie Appleby, both senior correspondents with Kaiser Health News, join me today. Welcome to you both.

Congress is still on a break for Easter and Passover. Before they left, Republican law makers were saying “repeal it.” That was the rallying cry. Now that they are back in their home districts, what is the chatter?

MARY AGNES CAREY: Well, they’re still out talking about “repeal and replace.” There are a lot of provisions of the bill they do not like. They feel that their electorate, their voters are with them, so I think you will continue to hear that when they come back to Washington, but that is going to be all but impossible.

The amount of work that was done to pass this bill, there are some very politically popular provisions (some will come now, some will come later) … make it difficult to repeal the bill. But Republicans are hoping this is going to help them get [more seats] in both the House and the Senate in the November elections.

JACKIE JUDD: And back here in Washington, implementation is moving ahead, slowly though. It is going to be a tough, rigorous process, mostly for the Department of Health and Human Services that now is charged with filling in some of the blanks that Congress left. What are some of them?

JULIE APPLEBY: Well, there is a lot. But there are at least four big ones they have got to tackle right away because they go into effect this year. The secretary has to define what is direct medical care? Because insurers have to report how much they are spending on this direct medical care and that is important because next year if they don’t meet certain spending targets, they have to issue rebates to consumers, so they are working on that.

They are trying to decide: what is the process for keeping young adult children on your policy if you are a parent? [The law says] kids can stay on it until they are 26, but when is that going to happen? Is it going to be during open enrollment? Will there be a special enrollment period for folks? They have got to define some of that.

The secretary is also going to [restrict insurers from setting annual dollar limits] starting this year, and that is going to affect all types of health policies. But first she has to draw up – what is an essential benefit package? So, they have got to decide that. And then they have got to decide if they’ll put dollar] restrictions on some of [the nonessential benefits] this year.

And they have also got to come up with a way how small businesses are going to apply for these tax credits that are going to be coming available this year.

JACKIE JUDD: As you were reporting the story, and you talked to small business owners, individuals, how much anxiety, relief, and confusion did you sense among the people you were talking to?

JULIE APPLEBY: All of the above, I mean people are just wondering “what does this mean for me? What do I have to change? What do I do?” Benefits consultants are telling me, boy, their phones are ringing off the hook. They are trying to explain this even as they don’t have all the details because the secretary has not come up with all the details, so it is a time of confusion out there.

JACKIE JUDD: But also a time of some urgency for the Obama Administration because, of course, they want to have some deliverables that the public can read about, feel, hear for the campaign in November.

MARY AGNES CAREY: Absolutely. One of the most immediate deliverables is this high risk pool. They want to have it up and running in 90 days. It would be for folks who have been denied health coverage based on a pre-existing medical condition. They have been without coverage for six months.

The secretary of HHS is reaching out to states that may have a high-risk pool. “Do you want to expand that one? Would you like to start a new one? If they don’t have a risk pool, do you want to start one? Should HHS step in?” That is one of the most immediate deliverables. 

And, as Julie mentioned, the idea of keeping an adult child on a policy until age 26, we are stopping the practice of recissions, denying coverage when you get sick. These are all immediate deliverables they want the public to know about because more of the major provisions as we know will come into effect in 2014.

JACKIE JUDD: Is it practical to think that the high risk pools, where they are needed, the few states that don’t have them now, 90 days, is it practical? You have covered the story for a long, long time.

JULIE APPLEBY: It is going to be a lot of work. They are going to have to move very fast. And how are they going to coordinate with the states?

Because, like you said, a lot of states already have these but they have different rules. And this federal [high-risk pool] is going to cover everybody, with no preexisting-condition exclusions, whereas some of the state plans do have those conditions. So how are they going to work all of this out? I think it is going to be challenging.

JACKIE JUDD: One last question, a little bit of a left turn from what we have been talking about, but inside the Beltway, eagerly awaited, is the report that we frequently get on the fiscal, the financial health of Social Security and Medicare. The Obama Administration has asked for a delay in issuing the next report. Why?

MARY AGNES CAREY: Well, they are hoping that [the new law] will show a positive impact on the Medicare Trust Fund. For example, the changes they want to make in the program — to link the payment based on the quality of service delivered instead of just how many services are performed, the changes they are going to make on the Medicare Advantage rates, the bundling (the payment of a variety of services all at once versus parceling out to each provider) — they’re are hoping these will have a beneficial effect [on Medicare] so they can show that.

 Again, perhaps that would be one of those early deliverables you could show to consumers how “health reform will benefit you.”

JACKIE JUDD: Okay, thank you both very much, Julie Appleby and Mary Agnes Carey. I’m Jackie Judd and this has been Health on the Hill.

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