President Obama's health care law is "here to stay," but cannot fulfill its promise if states do not expand Medicaid and the uninsured do not take advantage of the benefits designed to put coverage within reach of millions more Americans, Health and Human Services Secretary Kathleen Sebelius said Monday.
Addressing the National Health Policy Conference in downtown Washington, Mrs. Sebelius said the Patient Protection and Affordable Care Act of 2010 remains the "law of the land" after the Supreme Court upheld its key provisions in June and Mr. Obama won re-election in November, but several moving parts must sync up before the reforms can be fully effective.
"So my challenge to all of you today, and actually my plea to all of you … is help us speed up the rate of change," she said.
The administration got a piece of welcome news Monday when Ohio Gov. John Kasich, a Republican who has criticized the president's health reforms, announced he will accept federal money to finance a Medicaid expansion in his state so that 365,000 poor Ohioans will have coverage in 2014 — setting up a potential clash with the Republican state legislature.
State lawmakers in some Republican-led states have said they fear they cannot afford the expansion, even though the federal government will pick up 100 percent of the tab for three years before scaling down its contribution to 90 percent by 2020. But Mr. Kasich joins Arizona Gov. Jan Brewer and at least three other GOP governors in accepting the federal Medicaid funds offer from Washington.
Emphasizing the key tenets that led to the health care law's passage, Mrs. Sebelius said affordable coverage for millions more Americans will result in a more efficient and cost-effective health care system.
"It's good for all of us," Mrs. Sebelius said. "We all benefit when our premiums are no longer inflated with tens of billions of dollars in added costs for uncompensated care."
But Mr. Obama's reforms have faced challenges at every turn, as debate over the contentious law's implementation shifts to statehouses — many dominated by Republicans — across the country. Half the states have told the federal government to take responsibility for the insurance marketplaces, or "exchanges," that will be set up in each state to allow consumers to buy insurance through tax credits from the government.
States are having an even harder time deciding whether to expand their Medicaid programs to cover those making up to 138 percent of the federal poverty level, after the Supreme Court made it an optional part of Mr. Obama's law.
On Monday, Mrs. Sebelius urged states to take the money.
"The snapshot is, the states are being offered an incredible deal," she said, "and I say that as a former governor who would've loved to have had this deal at any time from the federal government."
Rep. Michael C. Burgess, Texas Republican, who also addressed the health conference on Monday, said federal agencies complicated the law's rollout by waiting until the presidential election to outline how, exactly, it would be implemented.
"There was not a lot in the way of honesty coming out of the agencies prior to that special date in November," said Mr. Burgess, a doctor who co-chairs the Congressional Health Caucus.
He said the Obama administration should have brought local leaders into the fold from the start of the policy-making process.
"All the anxiety you're seeing play out now is because the governors were not included," he said, adding it will be difficult for states to have their health exchanges ready by Oct. 1.
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