In a letter to President Obama from the Republican Governors Association last week, the GOP governors congratulated Obama on his re-election but wasted no time getting to the reason for the letter: Mr. President, your Patient Protection and Affordable Care Act (PPACA) “will be an enormous strain on state governments and budgets.”
Deadlines are a key concern, said the letter, written on behalf of the 29 Republican governors and the two governors-elect from the party.
First, the governors say they want some deadlines on submitting plans for the health care exchanges delayed until final regulations are adopted and all “stakeholders” have an opportunity to comment on them and the comments are “incorporated into the final rule.”
The rulemaking process, the governors say, “ has been unduly condensed and, in some cases, important rules have not been promulgated at all.”
In the near term, the governors say they need to better understand how the federal government will implement a federal exchange as it is clear most states will not be ready on their own.
While the January deadline to certify if a state is prepared to implement a state based exchange is statutory, most other deadlines are written within the discretion of the U.S. Department of Health and Human Services (HHS), the governors note.
The GOP governors say states are struggling with many unanswered questions on the health care law and are unable to make comprehensive far-reaching decisions prudently. “In the past months, we have sent letters with many specific questions to help us make an informed choice, and our letters have been generally ignored,” they say.
In specific objections, the Republican governors say the health care reform does not contain much-needed Medicaid reform designed to control costs.
“If we don’t get control over costs, then it is going to be very difficult for us to expand coverage,” they say.
They urged the White House to provide states with more flexibility on Medicaid and waivers “to allow governors to manage Medicaid costs better.
“As has been stated many times, before making any final policy decisions, governors must carefully consider the short and long-term implications of an expanded entitlement program and the consequences of significantly increasing the size of government to manage these programs.”