“Far from what’s reported as a federal takeover, the law really gives states maximum flexibility in shaping their own markets. States can decide for instance to fully operate their marketplace, to partner with HHS to run pieces of the exchange or to have us do it all,” Sebelius said.
“In fact, the law contains a provision that if states come up with their own way of covering the same number of people with the same kind of quality and now cost increase, they can present a plan and take over the whole system,” she said during her speech at the George Washington University School of Public Health and Human Services.
President Barack Obama has asked Congress to move up that provision of the Affordable Care Act, or Obamacare, to 2014, instead of when it was originally supposed to be implemented – 2017.
“And yesterday, I received letters from 12 governors (who) say they are already fully engaged in planning to establish their own marketplaces. We anticipate more to be fully ready as we move through 2012, but in the months to come, we’ll keep working with states to meet them where they think it’s appropriate and have all the exchanges running in every state by 2014,” Sebelius said.
She announced another key change that will go into effect in 2014. States will begin receiving “a very generous federal match to expand Medicaid coverage to uninsured adults at 133 percent of poverty.”
“Now those of you who don’t walk around with the poverty tables in your head, that means that for an individual you make less than $15,000 a year, and for a family of four, the income is less than $30,000 a year, so we’re really talking about some of the poorest working families in this country,” Sebelius said.
Sebelius said that Republican efforts in Congress to repeal the health care law could subject middle-class families "once again to some of the worst insurance abuses."
"When we have - as we have again today - people talking about repealing the law, I think it's important to remember what's really at stake. This has nothing to do with the fortunes of elected politicians around Washington - all of whom, by the way, already have excellent health care. It's the health and economic security of middle class families around America that are really at stake, so repeal actually could subject those families once again to some of the worst insurance abuses," she said.
"We know it would automatically raise the price of seniors' medications and add financial barriers to their preventive care. It would end the tax credits that are currently helping small business cover their employees and force millions of young adults to once again begin their careers without the security of health coverage, and it would mean that too often, the best quality of care would continue to be out of reach for most Americans," Sebelius added.
"What we know is that the Supreme Court decision - there were four justices who actually voted to strike down the entire law - would have accomplished those goals, but the majority of justices has allowed us to move ahead on full implementation of the act," she said.
"And with the slight change in Medicaid, which now makes the program a voluntary program and removes the penalty phase of Medicaid so that the Department of Health and Human Services could not take all of the underlying Medicaid funding away from a state who chose not to participate, Medicaid expansion will operate very much like the CHIP expansion has operated over the past number of years, where states voluntarily come into the program," Sebelius said.
"And we think that given the very generous framework of state-federal participation and the opportunity to ensure the largest number of lower-income adults in that program that states will indeed decide to insure their populations," she added.