- The Washington Times - Wednesday, January 22, 2014

President Obama’s top health official urged the nation’s mayors to take an active role in demanding their states expand Medicaid, calling out Texas, Florida and Georgia as states that put low-income residents at risk of losing out on any form of subsidized coverage.

“I really do believe that mayors are on the forefront of health care delivery in America,” Health and Human Services Secretary Kathleen Sebelius told the U.S. Conference of Mayors, holding their annual gather in Washington this week.

Medicaid’s expansion has been one of the thorniest parts of the Affordable Care Act — particularly after the Supreme Court gave states the option to reject the new federal funds offered to implement the expansion.

About half the states have refused to expand the program, citing fears of the long-term costs. But that has left some residents earning too much for Medicaid but too little to qualify for income-based subsidies that would help pay for private coverage on Obamacare’s new health markets.

Mrs. Sebelius said the federal HealthCare.gov enrollment website was working well after an October launch that was “rocky, to say the least.” Even so, she acknowledged that the government is still building back-end systems that will help states process Medicaid enrollments among people who learn they are eligible through the federal web portal.

She made her pitch at the same time her agency released figures stating 6.3 million new beneficiaries have been determined eligible for Medicaid or the Children’s Health Insurance Program through state agencies and state-run insurance markets tied to the health care law. The new data does not account for people who’ve been determined eligible for the health entitlements through the federal marketplace, HealthCare.gov.

Obamacare has been a partisan battleground on Capitol Hill for more than three years, but it tends to be more of an administrative challenge than a political wedge on the municipal level, according to mayors at the three-day summit in downtown Washington.

For some, the health care law’s “employer mandate” to provide health insurance to workers is a conundrum they’re still trying to solve.

The mandate requires employers with more than 50 full-time workers to provide health coverage or pay fines. However, the rule defines “full-time work” as at least 30 hours per week instead of the traditional 40-hour week, creating confusion among municipalities that employ a large number of people they consider to be part-time workers.

Mr. Obama delayed the mandate’s implementation by one year, to 2015, but municipal leaders say they are trying to make their plans now.

Joy Cooper, the Democratic mayor of Hallandale Beach, Fla., said her town of about 38,000 residents calculated that it will cost about $800,000 per year for them to provide health coverage for part-time municipal workers who put in at least 30 hours per week. She said she supports Mr. Obama’s reforms overall, but how to proceed with part-timers “is a decision that has to be made.”

Shane T. Bemis, Republican mayor of Gresham, Ore., said his own insurance policy was canceled because it did not meet Obamacare’s requirements. The website for Cover Oregon, the state’s once-promising health exchange, has faced major technical problems and forced officials to process paper applications late last year. The result, Mr. Bemis said, is widespread confusion.

“I go to the state site to try and figure that out, and it kicks us out,” he said, adding, “I think there’s just a lack of information and knowledge.”