Posts Tagged ‘governor’

Health Benefit Recommendations Offer States Reform Incentives

October 13, 2011

By Robert Holden, Senior 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

October 4, 2011

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.

Do You ‘Recall’ When…

September 6, 2011

By Stateside Associates

This summer the state of Wisconsin held nine general state legislative elections in an unprecedented attempt to recall Senators from both political parties. Prior to Wisconsin’s summer of recalls, only 20 legislative recall elections had ever been held in the United States.

The recall effort in Wisconsin was a historical first, overwhelmingly negative 1, nationally covered, costly to taxpayers, and funded in large part by out-of-state interests. Wisconsin’s recalls raise many questions about the recall process itself. How many states have the ability to employ the recall and how do the rules vary? Is this historically rare check on elected officials going to become commonplace and if so, how do we as state government practitioners participate in the process—or avoid it all together? What effects would an increase in recall attempts have on effective governing and our ability to engage lawmakers?

The background of the recalls in Wisconsin stems from a spring and summer fraught with discord in the state house. As the Republican-controlled legislature and Governor Scott Walker (R) moved to approve a budget before the end of the fiscal year, daily protests and a tent city of opposition sprung up at the Capitol. At the same time, campaigns were mobilizing concerning the upcoming recalls that were in response to the Governor’s proposal that changed the collective bargaining rights for state employees and went into effect June 29, 2011.

Initially, eight Republican members faced potential recalls for supporting the legislation to limit bargaining rights while eight Democratic members were targeted for fleeing the state for several weeks. In the end, petitions to launch recall elections against six Republican members and three Democratic members were successful. In August, all nine general elections were held and Republicans held onto a slim 17-16 majority in the Senate with four of the six Republican Senators retaining their seats and all three Democrats retaining their seats.

The recalls in Wisconsin highlighted a process that is rare and limited in state legislatures. Currently, only 18 states have a process by which citizens can recall legislators. In seven of these states there must be specific grounds for a recall petition (e.g. misconduct). Wisconsin is one of 11 states that have no stipulations about grounds on which the recall is based, thus allowing for its use as a political weapon. Furthermore, each recall petition begins with a signature collection requirement. The majority of the states require a percentage of the vote from the last election for the office being recalled and three states require a specific percentage of the votes cast for governor in the targeted district. Required signature thresholds range anywhere from 15 to 40 percent; Wisconsin’s requirement sits at 25 percent.

Wisconsin voters thus brought nine Senators up for recall elections. Is this simply an isolated event due to internal strife in the state or might there be a trend toward greater use of the recall as a political bludgeon? Before 2011, there had not been a recall election in the states since 2008; this year has seen nine, with more on the horizon.

Arizona will hold a recall election on its Senate President Russell Pearce (R) in November and recall petitions are pending in Alaska and Michigan where two members are being targeted. (Interestingly, in all of these states Republicans control the Houses, Senates and Governors seats). It seems clear that at least for the moment recall elections are gaining momentum. Is the cause of the recall surge a sign of the discontent caused by financial struggles in the states, a backlash against the Republican swing of 2010, or simply a fluke?

Fluke or not, there are indications that lawmakers in Wisconsin may attempt to restrict the recall. Citing the cost to taxpayers and the influence of outside special interests, Wisconsin Representative Robin Vos (R) released a statement declaring an intention to introduce a constitutional amendment concerning the recall procedure in the fall.2 And while lawmakers may mostly be concerned over the recall’s political and financial effect, those working to influence the process may be more concerned for the consequences to good governance.

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States with recall provisions include (bold has a grounds requirement): Alaska, Arizona, California, Colorado, Georgia, Idaho, Kansas, Louisiana, Michigan, Minnesota, Montana, Nevada, New Jersey, North Dakota, Oregon, Rhode Island, Washington, Wisconsin

Footnotes:

(1)    http://www.jsonline.com/blogs/news/128618163.html

(2)   http://www.wispolitics.com/1006/081011_Vos.pdf


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