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States At The Heart Of Implementing Health Care Law
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States At The Heart Of Implementing Health Care Law

Health Care

States At The Heart Of Implementing Health Care Law

States At The Heart Of Implementing Health Care Law
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Many Republicans want to repeal the health care law. At the same time, state governments face an obligation to help put the law into effect. Alan Weil, executive director of the National Academy for State Health Policy, tells Renee Montagne what states are facing as they begin to implement the new health care law.


And as Andrea just noted, high on the agenda of many Republicans is a repeal of the health care law passed by the last Congress. We're going to step back from the scene in Washington now to look at where things stand with implementing that law.

Alan Weil is the executive director of the National Academy for State Health Policy. He joined us to take stock of what's going on at the state level.

Mr. ALAN WEIL (Executive Director, National Academy for State Health Policy): States are at the absolute heart of implementing the new health care law. Timelines are tight, even though many of the provisions don't actually take effect until 2014.

If they can have a productive discussion and debate in 2011, they can set the course and meet the timelines. If they're stuck, either because of political battles or ideological divisions that they can't overcome, they're going to find themselves in a very tough position trying to catch up in the next couple of years getting done what has to be done to implement the law.

MONTAGNE: A major provision of the law involves health care exchanges. States are designing their own. What is there to know about those exchanges?

Mr. WEIL: Health insurance exchanges create a marketplace where consumers -whether it's individuals or small businesses - can come and see a set of coverage options. They'll have tools to compare them on price, on benefits, on quality. It's a marketplace that's designed to function more efficiently with more information, more transparency than anything we have today.

The second role that the exchange performs is to be the conduit for federal tax credits that are designed to reduce the cost of insurance for people who don't have coverage through their job. So if your employer does not offer coverage, you can come to the exchange, you have the choices of plans that anyone would have, but you also will be able to obtain a federal tax credit that will reduce the cost of that coverage.

MONTAGNE: And what is the range of things states could be doing? And, in fact, from what you know, give us some examples of what they are starting to do.

Mr. WEIL: We should expect a pretty broad range of state approaches. The federal law is quite broad, and so states can either adopt what is often termed as a highly regulatory or aggressive purchaser model, where they actually negotiate prices with plans. They exclude plans that they feel are not offering the value or the product that the state feels is appropriate to sell.

At the other extreme, we would expect to see some states take all comers. If a plan is licensed to offer products in that state and they offer products within the broad parameters of what the federal law requires, they can sell their wares on the exchange. It's a less regulatory approach at the state level, and I think we should expect to see everything from one end to the other, to many in between.

MONTAGNE: Could you give a specific example of each of those versions?

Mr. WEIL: Many people refer to Utah now as a model for a free market exchange. They set this up prior to enactment of the federal law. So it doesn't do everything that an exchange has to do under the new law, but its general approach is to create an open door for insurance plans. There's no regulatory role for the exchange. They're simply passing on whatever the insurance companies offer to the consumers who want to buy them.

Massachusetts is often held up as the other end of the spectrum, if you will. They are more active in how they select the insurance plans that can participate in their insurance exchange. They negotiate over rates. They are more structured in terms of the benefit design. They have data and reporting expectations that purchasers might demand, but that in a Utah model, are not expected of the plans.

So those are not necessarily the book ends, but those are the two real world examples that people tend to point to to show the two different approaches.

MONTAGNE: Well, do you think the law is as politicized at the state level as it has been at the national level?

Mr. WEIL: The law is as politicized at the state level as it is at the federal level, which is not often the case. But there's more motivation and I think more trust and more good will that lets you move from that ideological and political disagreement to actually developing policies that help the people in your state.

MONTAGNE: Thank you very much for joining us.

Mr. WEIL: Oh, you're quite welcome.

MONTAGNE: Alan Weil is the executive director of the nonpartisan National Academy for State Health Policy.

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MONTAGNE: You're listening to MORNING EDITION, from NPR News.

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