Lessons From Virginia, Iowa

By Heather Williams, Vice President at Stateside Associates

(Excerpt reprinted with permission from Governors Journal)

Virginia has given us insight into how national issues are going to play in state elections in 2012.

Despite all efforts by Virginia Democrats to make their campaigns for state Senate about state issues, Republicans worked determinedly to tie all Democrats to an unpopular president.  This is for good reason.

Quinnipiac has Governor McDonnell’s approval rating at 62% whereas Rasmussen Reports President Obama’s approval rating at 45%. The clearest example of the Republicans’ goals to tie candidates to the president came in the form of a quote from Virginia GOP spokesman Garren Shipley: “Virginians face a choice—do they want Washington, Obama-style leadership, or do they want Virginia, McDonnell-style leadership?” If Democrats wanted to win, their mandate was to fight back against these types of linkages. They knew going into their races that they couldn’t win talking about national issues and so they worked tirelessly against allowing the Republicans to draw clear lines between Democratic candidates and the president.

In the end, Democrats struggled to distance themselves from the president and his national agenda, but those who did were largely successful. Senator Phillip Puckett(D) publicly stated in September he would not be supporting the President in 2012. Despite that statement, Republicans aired an ad linking Senator Puckett to President Obama and his “job killing” national agenda (Puckett won with 53 percent of votes cast). Democrats tried so hard to keep the campaigns about Virginia and Virginia issues that Senator George Barker’s(D) campaign…

READ FULL ARTICLE AT GOVERNORS JOURNAL

 

Health Benefit Recommendations Offer States Reform Incentives

By Robert Holden, Vice President

The Institute of Medicine (IOM) recommendations for Essential Health Benefits, released October 6, may have injected new life into state planning for health benefit exchanges during the upcoming 2012 legislative session. The IOM’s recommendations establish a process for identifying the benefits that will become the basis for health plans available to individuals, small businesses, and eventually to larger employers through each state (and any federal) health benefit exchange. The federal rules that emerge from this process will have a profound effect on insurance regulation in the states, as they will impact all state health insurance benefit mandates currently imposed on health insurance carriers.

Since the enactment of the Affordable Care Act (ACA), state policy makers have known that they would be required to pick up the cost of any state mandates imposed on plans offered through a state health benefit exchange that exceeded the federal essential benefits. As a result, states have already introduced legislation and established commissions to review state mandated benefits in anticipation of the federal rules. With the release of the IOM recommendations, it appears that states may have much more control of which mandate benefits they will be able keep.

States Pace Their Implementation Efforts on the Availability of Federal Guidance

The race towards the ACA’s 2014 deadline to implement state health benefit exchanges has become a “chicken or egg” process between state policy makers and the HHS, as states delay implementation while waiting for federal guidance. The release of federal rules on exchange governance came this summer, after many state legislatures had already adjourned. Federal rules on benefits are still pending, even as state planning and interim activity increases for the 2012 legislative session. States are particularly dependent on the HHS rules addressing essential benefits, as the ACA statute provides only broad benefit categories, such as “Prescription Drugs,” that must be made available in health plans. The IOM recommendations did not narrow the benefit categories for states, as IOM was authorized to provide the process for determining essential benefits and not the specific benefits themselves.

Opportunities for State Policy Makers

While state activity on specific benefits is still delayed, the IOM recommendations do offer some direction to state governments, starting with small group health plans. If it proceeds as recommended, HHS will begin with the benefits offered in a current, typical, small business health plan. These benefits will then be supplemented with additional required services so that each ACA benefit category is met. HHS will also develop an ongoing review process to account for future health technology advances and new benefits.

More importantly for state policy makers, IOM recommends that states have the flexibility to create alternative benefit structures, if they establish an exchange. Additionally, in comments made during the IOM’s release of their recommendations, it became clear that the IOM believes that states should decide how benefits addressing disabled and transitional Medicaid populations are structured. These recommendations not only give state officials additional flexibility and control over benefit mandates, they may provide needed incentive to continue implementing ACA exchanges. While it remains to be seen how states still considering their plans for implementation will react, this new incentive puts even more focus on the release of federal essential benefit rules and the formal authorization of states to create alternative benefit structures for their state exchanges.

2011 State Races Presage 2012 Vote

By Steve Arthur, Vice President

Updated October 5, 2011

While the Republican presidential debates have been the focus of the national media in recent weeks, there are state elections this fall that may provide some early indications about what may happen at the ballot box next year. 

One early indicator was this week’s special election in West Virginia to fill the remaining year of Joe Manchin’s gubernatorial term (Manchin was elected to the U.S. Senate in a special election last year.) Acting Governor Earl Ray Tomblin had been leading Republican Bill Maloney by huge gaps early in the race, but a Public Policy Polling poll released a day before the election showed Tomblin’s lead down to a single point. With the Republican Governors’ Association (RGA) airing a television ad tying Governor Tomblin to “ObamaCare,” an upset victory by Maloney would have shown that Democrats who supported the health care plan should continue to be worried. In the end, Tomblin was able to win a narrow 50%-47% victory.  Although, the lead paragraph of the AP story on the result said Tomblin won by “successfully distancing himself from the Obama administration and the president’s health care plan.”  This is not going to help Democrats sleep very well.

There are three other gubernatorial elections this fall, although the outcome of those races does not seem in doubt. Republican Governor Jindal is an overwhelming favorite to win a second term and may very well do it by winning over 50% in the open primary on October 22. In Kentucky, Democratic Governor Steve Beshear is now leading his Republican opponent by 31 points in a new WHAS/Courier-Journal poll and should have no trouble winning re-election. And in Mississippi, Republican Lt. Governor Phil Bryant should cruise to victory in his race against Hattiesburg Mayor Johnny DuPree.

While the Mississippi Governor’s race may not keep people up late on Election night, the state House of Representatives races might.  With the Mississippi Senate already controlled by Republicans, Democrats want to maintain control of the State House.  However, as the Wall Street Journal has reported, Republicans are making a major effort to take control of that body for the first time since Reconstruction. They have brought in a campaign strategist who led the Republican effort in North Carolina to take control of that state’s legislature. Eight seats need to change from (D) to (R) in order for Republicans to take control, and if they don’t succeed in flipping the chamber, I believe they will come very close.

In Iowa, a special election will be held November 8 for a State Senate seat that became vacant when Governor Branstad’s appointment of Democratic Senator Swati Dandekar to a state board. As the Des Moines Register reports, the Senate district has more registered Republicans than Democrats, so it is a prime target for a party switch. What makes the seat especially important is that Democrats currently have a one seat majority in the Senate, so if Republicans were to win the seat, the chamber would be evenly divided between the parties. There is no mechanism to break ties in the Iowa Senate (Lt. Governor has no role), so a power sharing agreement will need to be reached if the seat flips. Again, with Republicans much more enthusiastic about voting nationally than Democrats, the GOP could take another chamber away from Democratic control, even if it is just to an even split.

Finally, Republicans are making an all out push to take back control of the Virginia State Senate, which they lost in 2007. They would need to take 3 seats from the Democrats to regain control, and they are making a major push to win those seats.  Governor McDonnell, whose victory in 2009 began the Republican resurgence after the drubbings they took in 2006 and 2008, has been actively involved in the effort to take back the Senate according to the Roanoke Times. Taking three seats may be tough, but again, the enthusiasm gap Republicans currently enjoy might be enough to make that happen.

Any single race can be dismissed by the losing party as a fluke, but Democrats should take some comfort in the West Virginia victory.  However, a 3 point victory in a state with a 2-1 Democratic advantage is not something I would point to as a harbinger of better times ahead.  If the Republicans are able to run the table on the legislative races – taking control of the Mississippi House, Virginia Senate and winning the special election in Iowa—Democrats should remain very concerned about their prospects in 2012.