Saturday, September 18, 2010

Michael Ciamarra: The Checklist - Where are your papers?

  A document from the National Conference of State Legislatures recently came across my desk innocently entitled, "State Legislators' Check List for Health Reform Implementation." I was astonished, to say the least, at the check list of sweeping mandates, requirements to change state law to 'conform,' questions on who will run state high-risk pools, Medicaid funding ratios and dozens of different complex challenges for 2011 state legislatures in order to comply with the newly enacted Obama health care law.

  The Obama Administration will move forward with this implementation, along with the creation and expansion of 159 new federal offices charged with administering, which also means Alabama's new governor will be faced with multitudes of complications to be implemented as required by federal law.

  Requirements for implementation required by the new federal law are just beginning - the main provisions of the federal health plan do not even go into effect until 2014!

  Rarely a day goes by when a provision isn't discovered in the bill that caused House Speaker Nancy Pelosi to infamously declare, "We have to pass the bill so that you can find out what is in it, away from the fog of controversy." Every state legislator I have spoken with says the same thing: 'What have they gotten us into?  ...I hope it will be repealed.'  Unfortunately, in the meantime, the federal government is waiting with their implementation check list for states!

  State legislatures aren't the only ones who will be compelled to act in the near future. The new federal law requires taxpayers and businesses to 'comply' as well. For example, beginning in January 2012, businesses are required to file with the IRS for EVERY business-to-business transaction over $600. Beginning in January 2011, consumers are not allowed to use market-based health savings accounts, flexible savings accounts and the like to purchase over-the-counter medicines. The minutiae of new rules and regulations are daunting!

  Certainly, the issue that will loom largest in health care changes is Medicaid. Alabama's $5 billion a year program provides health services to nearly one million people in our state. Starting in 2014, Obama's health care law also expands the number who will be eligible for Medicaid to include all individuals with family incomes at or below 133 percent of the federal poverty level. According to state budget documents, the federal government upped its share of funding for the program by three-fourths during these difficult financial times. The extra funding will expire and the next governor will be faced with tough decisions to have adequate resources to cover Medicaid and not cut basic services. The Obama Administration has made it difficult for states in dealing with their Medicaid programs. States are not allowed to make changes to eligibility standards or to many of the services provided under the program.

  The November elections could bring control of both chambers of Congress to the Republicans and with polls like Rasmussen affirming that nearly two out of three Americans want the Obama health care law repealed, a Republican-controlled Congress would begin the process of repealing this colossal, centralized health plan.

  During the health care debates the Republicans were shut out of the amendment process. But a Republican-controlled Congress working with President Obama in the White House will mean that the process of repeal will be drawn out over a long period of time.

  Which brings me to this question: What if Congress is successful, over time, in scaling back or outright repealing the Obama health care plan? I believe the states are really where health reforms and innovation should occur. What have the two candidates running for Alabama's governor suggested as rational, workable policy proposals for state lawmakers to consider?

  A review of Democratic candidate Ron Sparks' public statements on health reform does not reveal much. The Birmingham News reported that Sparks said "...the federal overhaul of health care is now the law and state legislators early next year must take up measures to come into compliance with it." What is his approach to health care reform, especially if Obama's health care law is repealed? As you might expect, he proposes to rely on regulating and taxing gambling as a way to raise money to fund public health programs. Nothing new there.

  The Republican candidate, Dr. Robert Bentley, is much more detailed and thoughtful in laying out state-driven reform measures. Bentley does not mince words on the Obama health care plan, "It's the worst thing that has happened in this country and as governor I will stand up and fight it." Bentley is also prepared with a number of reforms that will create a 21st century approach to personal health care and access.

  Bentley would like to create competition among insurance companies which, he believes, would drive down the cost for Alabamians. His plan expands tax incentives to companies to provide wider health insurance coverage.

  Very significantly, Bentley's plan also would establish Health Savings Accounts which would allow consumers to contribute pre-tax funds into the account dedicated to paying for medical costs. Coupled with high deductible insurance policies, Bentley argues that it will save Alabamians millions of dollars. Bentley also suggests creating health savings accounts as a way for state and education employees to address health insurance costs, retirement costs and state pensions.

  Significantly, Bentley wants to create incentives and opportunities for more primary care physicians.

  On health care, the differences in the two candidates couldn't be any starker. One continues to applaud and support a centralized, unworkable, bureaucratic healthcare plan centered in Washington. The other supports repealing President Obama's plan and replacing it with state-driven, common sense health reforms which will improve health delivery and allow every individual to access through lower costs and better care.

  About the author: Michael Ciamarra is vice president of the Alabama Policy Institute and Alabama chair for American Solutions. He can be reached at

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