The National Conference of State Legislatures held its Fall Forum on Dec. 5-7, 2012, in Washington, D.C. At the Forum, I represented HIMSS at multiple workshops on issues as diverse as Expanding Employment for Military Veterans and the meeting of the Task Force on Federal Health Reform Implementation, which included a session about the State Insurance Exchanges and Medicaid expansion.

During the Veterans workshop, I learned about the work being done in states to expand and grow job opportunities for our military veterans and ensure they receive the benefits they deserve. Representatives from the U.S. Department of Veterans Affairs included Deputy Assistant Secretary John Garcia.

Mr. Garcia oversees VA’s Intergovernmental, Tribal Government, and International Affairs programs; Consumer Affairs Program; and National Outreach Program.  As the lead for the Intergovernmental Affairs office, he works with state and local governments and business to make sure veterans not only receive employment opportunities, but his office also works with small businesses owned by veterans. He was recently highlighted on Rundown, a show hosted by Chuck Todd.

The afternoon session of the Forum was the Task Force on Federal Health Reform Implementation.  The discussions centered on the major provisions of the Patient Protection and Affordable Care Act slated to go “live” in just 12 months.  State representatives at the meeting reported out from their states varied widely.  Many have implemented early parts of the law, while many others deferred decisions or expressed opposition during 2012.

During the panel Overview: Where Are We Now?, the speakers included Gary Cohen, the Deputy Administrator & Director for the Consumer Information and Insurance Oversight (CCIIO) Centers for the Centers for Medicare and Medicaid Services.  During his remarks, Cohen said 15 states have turned in the official yes to the feds and at least another five will do a state-federal partnership exchange. The fence sitters have until Dec. 14 to decide. 

Cohen made it clear the Health and Human Services Department will operate as many FFEs as it has to, despite skepticism that implementing more than half of the state exchanges in a matter of months is too big an order. “There WILL be an exchange in every state,” Cohen said.

During the panel on Medicaid Reforms, Cindy Mann, a deputy administrator of the Centers for Medicare and Medicaid Services said that while “there is no deadline” for expanding Medicaid, states would pay a price for delay.

Under the new law, she said, the federal government will pay the entire cost of Medicaid coverage for newly eligible beneficiaries for three years, from 2014 to 2016. The federal share will decline to:

• 95 percent in 2017;
• 94 percent in 2018;
• 93 percent in 2019; and
• 90 percent in 2020 and later years.

The federal payment rates “are tied by law to the specific calendar years noted,” Ms. Mann said. So, if a state defers the expansion of Medicaid to 2016, the federal government will pay 100 percent of the costs for only one year. After 2016, the federal share will drop to the levels specified by Congress, and states will be responsible for the rest.

Ms. Mann urged the state legislators in the room “to take advantage of the opportunity provided to insure their poorest families with these unusually generous federal resources.”

Also on this panel was Matt Salo, Executive Director of the National Association of Medicaid Directors, who discussed the states newly flexible role to select if, when and for how long to accept the eligibility expansion to 133 percent of federal poverty guidelines. This was a great opportunity to hear these state and national experts discuss possible steps for the 2013 legislative session.

On the last morning of the Forum, I attended the plenary session, Partisan Gridlock:  Is There a Solution? Here, I heard from two former U.S. legislative giants who know a thing or two about how to get things done in Congress.  With a lot of discussion about the fiscal cliff and dozens of other looming critical issues, a pair of former senators told the nation’s state legislators Friday morning that Congress needs to work in a bipartisan fashion to address these issues.

Former Senate Majority Leader Trent Lott (R-Miss.) and former Sen. Byron Dorgan (D-N.D.) said that they want to see Republicans and Democrats on Capitol Hill start working together in a more bipartisan fashion on a range of issues. A solution is likely on the fiscal cliff, they said, but both parties need to work together to discuss other issues, including long-term tax reform issues.

My final meeting was at the Transforming Health Care Through Technology Foundation Partners Project, where I heard how GIS can play a critical role in

• improving quality of care;
• increasing accessibility of service;
• finding more cost-effective delivery models; and
• preserving patient confidentiality while satisfying the needs of the research community for data accessibility. 

It was an interesting session that taught me how harnessing geography can help improve healthcare outcomes.

I am grateful that I could attend the NCSL 2012 Fall Forum and meet with state officials and others to identify some of the challenges on policy issues the states will be dealing with in 2013.