Yesterday, during a speech at the National Press Club, Health and Human Services Secretary Kathleen Sebelius laid out the path forward for implementing the new health care law. The Secretary promised that HHS would serve as a “help desk” for Americans confused about the new legislation and would guide seniors and small businesses in taking advantage of the immediate benefits from reform.

Already, the IRS has compiled a fact sheet about which companies are now eligible for the new tax credit and “starting on June 15th, seniors who have hit the prescription drug donut hole will get a $250 rebate check to help them afford their medicines this year.” Here are some of the things HHS is doing/has yet to do to implement the new measure:

- Allow states to apply for Medicaid expansion funds: States can already states can apply for federal funding to expand their Medicaid programs to cover low-income people earning up to 133% of the federal poverty line ($14,404 for an individual and $29,326.50 for a family of four). This benefits states like Maine, Washington, Minnesota and a handful of others that already offer expanded coverage for low-income people but pay for it out of their own pocket.

- Establish high-risk pools: HHS has already asked states to decide whether they will participate in a new high-risk health-insurance pool, build on an existing program (if they have one), establish a separate state-based high risk pool with federal funding or do nothing at all, in which case the federal government would come in and administer the program.

- Define medical-loss ratio: Secretary has to define what constitutes direct medical care so that insurers can begin meeting the new medical-loss ratio requirements. The new law “requires that insurers spend at least 80% of customers’ premiums on medical care in the individual insurance market, and 85% in the employer/group market.”

- Establish which benefits insurers can set annual limits for: Insurers can place annual or lifetime limits per beneficiary limits on non essential benefits and can establish limits on the dollar value of essential benefits only as the Secretary shall determine. So, the Secretary has to define essential benefits and decide which benefits can be restricted this year.

- Issue regulations to protect children from pre-existing condition ban: Since the law only protects children who are already enrolled in a health care plan, the Secretary have to issue regulations that prevent insurers from denying coverage to newly enrolled children.

- Define the rules for 26 yr olds to stay on their parents’ policy: The Secretary has to establish guidelines for this provision, which goes into effect on September 23. Some potential challenges/questions: Will there be a special enrollment period for new dependent children? How will dependents be defined? Will insurers be able to jack up rates once adult dependents join the policy?

- More protections for seniors in Medicare Advantage: CMS has issued new guidelines that will protect seniors and people with disabilities from discriminatory cost sharing. They’ll also be to better compare plans in 2011.

Sebelius also push back against the growing number of states that are now suing the administration over the constitutionality of reform by arguing that reform is “actually a very state friendly bill.” “Many of the key reforms will be carried out by the states,” she said. “That’s why states will have the option to oversee the development of the insurance exchanges, regulations, and consumer protections”:

It’s true that part of the law makes health care coverage a partnership between the states and the federal government. That expansion starts in 2014. For the following three years, the federal government picks up the entire bill. After that, the states start paying up a share, which rises to ten percent by 2020. So there will be some new costs. But those costs are balanced by new benefits, including less spending on uncompensated care, savings from reduced insurance paperwork, more resources to cover children, and more money to crack down on fraud and abuse.

Sebelius also said that those suing the government over reform were doing so to advance their political careers and reminded everyone that implementation would have its challenges. “There will be twists and turns. It will not be easy,” Sebelius concluded.

While progressives generally support the new health care law, many remain disappointed that the plan did not include a public option, a national exchange, or stronger rate-review provisions. I share these concerns, but I’m also surprised that the administration did not include stronger malpractice reforms, particularly after it made a big show of incorporating Republican ideas into the final legislation.

Republicans like to talk about capping non-economic damages in malpractice suits. But since that’s failed to significantly reduce health care spending or lower the use of unnecessary treatments, some reform advocates have looked to other alternatives that would lower lawsuit abuse while also reducing the practice of defensive medicine. One such option is a “disclose and apology” model, which encourages providers to “deal with medical mistakes: [r]ather than stonewalling patients and relatives.” As the New America Foundation’s Joann Kenen explains these programs are reducing lawsuits and improving care in some hospitals:

Disclose and apologize doesn’t mean the hospitals or doctors say to a patient or family, “Something went wrong. We’re sorry. Here’s a check. Ciao.” It means, or should mean, they say something like, “You had a bad outcome. We are sorry. We will try to help you while we investigate what happened. If it was our fault, we will take financial and moral responsibility. We will do our best to make sure it never happens again to anyone else.”

Maggie Mahar makes one additional observation about the advantages of this model to the traditional conservative approach of simply capping rewards: “More importantly, tort reform does nothing to improve hospital safety. By contrast, hospitals that “disclose” also “fix.” No one pretends that that the hospital makes no mistakes. They trace what went wrong, (often it’s a system error) and repair.”

Indeed, Senator Obama co-sponsored so-called Sorry Works legislation that would have given physicians who disclosed their errors “certain protections from liability within the context of the program, in order to promote a safe environment for disclosure.” The administration may have been pressured against including the provision in this first reform package, but I suspect they’ll have to revisit it in the future.

I’ve maintained that the Attorneys General and now the Governors who are suing the federal government over the constitutionality of health care reform are doing so in their capacity as politicians, not lawyers or lawmakers. At least 4 of the AGs that have signed on to Bill McCollum’s case in Florida are running for higher office (including McCollum himself) and the rest are up for re-election. Gov. Jim Gibbons (R-NV) and Jane Brewer (R-AZ), who joined the lawsuit over the objections of their attorneys general, are running for re-election in 2010 and Gov. Tim Pawlenty (R-MN) — who also brushed aside his AG’s claim that the law is in fact constitutional — is likely running for President.

Meanwhile, the lawsuit itself doesn’t contain any references to past Supreme Court decisions or legal precedent that explain where the Court has agreed with their interpretation of the constitution. The plaintiffs regularly use buzz words like “unprecedented encroachment on the liberty,” “unfunded mandate” to condemn reform and argue that the law will be enforced by 16,000 IRS agents and will levy “any kind of amount of money” in new taxes.

It smells like a frivolous political stunt and now we have even more proof that it is. Ben Smith writes, “The campaign of South Carolina Attorney General Henry McMaster, who is seeking the Republican nomination for governor, is circulating this almost gothic video touting his lawsuit against health care legislation…..Which may, er, open the suits to the charge of playing politics.” Watch it:

But just because the lawsuit is frivolous doesn’t mean that it still can’t complicate the implementation process. As the Center for Budget and Policy Priorities points out in a new report, “efforts to nullify the individual mandate could weaken political support for health reform and make successful implementation at both the state and federal levels more difficult to achieve. States could delay changing state laws or laying the groundwork necessary to implement various reforms until lawsuits resolving the legality of the nullifications measures are decided.” As a New York Times article on nullification efforts noted, “the measures could create legal collisions that would be both expensive and cause delays to health care changes, and could be a rallying point for opponents in the increasingly tense debate.”

The Governors of Nevada and Arizona have joined 14 states suing the federal government over the constitutionality of health care reform, after the states’ attorneys general refused to join the lawsuit. Govs. Jim Gibbons (R-NV) and Jane Brewer (R-AZ) appeared on Fox News’ Greta Van Susteren to announce the challenge and — like the lawsuit itself — failed to convince anyone that the Supreme Court actually agrees with their interpretation of the constitution. Instead, both governors regurgitated the Tea Party Manifesto:

GIBBONS: Under Article 1 of the constitution, if the government is allowed to proceed with telling you what you must buy when you do nothing in regard to that, all of our Article 1 Section 7 limitations of federal power are for not, they’re out the window. There is no reason to stop the federal government from deciding on what you eat that day.

HUTCHISON (attorney representing NV): Particularly the individual mandate, which for the first time in United States history requires U.S. citizens to purchase a service or good in order maintain their good standing with the United States government. Otherwise, they’re going to get chased down by one of these 16,000 IRS agents.

BREWER: We just simply cannot sustain what they’re mandating us to do under the Medicaid part of it. And then again, with the people out there. It could be any kind of amount of money that they would be taxing the people of Arizona, unconstitutionaly by the way.

Watch a compilation:

Not surprisingly, both Gibbons and Brewer are running for re-election in 2010 and health care reform polls poorly in their states. Yesterday, Gov. Tim Pawlenty (R-MN) — who is likely running for the Republican presidential nomination in 2012 — announced that he would join the lawsuit, despite his attorney general’s belief that the health law was constitutional. HHS Secretary Kathleen Sebelius picked up on this trend yesterday and accused Republican state attorneys general of launching the suits for political purposes. “I think that the vast majority of lawsuits have been filed by Attorneys General in states where they have also some interest in higher office,” said Sebelius. “I’m going to let the lawyers go debate the situation. [But] we are confident that the legal standing of the law is solid and that this has more to do with politics than policy.”

Yesterday, North Dakota also joined the suit, bringing the total number of states on the Florida case to 17.