Following Arizona’s lead, Mississippi is moving to finalize legislation prohibiting insurers from offering abortion coverage in the exchange, even if it’s paid for with private dollars. The state legislature sent the bill to Gov. Haley Barbour (R) yesterday, after House leadership tabled a motion to re-consider.

In some ways, the Mississippi bill may be even more draconian than Arizona’s law. While women in Arizona would still be able to purchase an abortion waiver with private dollars in an exchange, women who want to buy abortion coverage in Mississippi that goes beyond the life of the woman or if the pregnancy is the result of rape or incest, would be forced out of the exchange. From Senate Bill 3214:

SECTION 2. Legislative findings and purposes. (1) The Legislature of the State of Mississippi finds that Section 1303 of the federal Patient Protection and Affordable Care Act, states are explicitly permitted to pass laws prohibiting qualified health plans offered through an exchange in their state from offering abortion coverage.

(2) It is the purpose of this act to affirmatively opt out of allowing qualified health plans that cover abortions to participate in exchanges within the State of Mississippi.

SECTION 3. Opt-Out. (1) No abortion coverage may be provided by a qualified health plan offered through an exchange created pursuant to the federal Patient Protection and Affordable Care Act within the State of Mississippi.

Health reform has opened a Pandora’s box of state efforts to restrict abortion coverage by removing coverage from the exchange and placing other restrictions on abortion access. Most recently, the Oklahoma Senate overrode the governor’s veto to pass a law that requires “women seeking an abortion have a viewable ultrasound and listen to a detailed description of the fetus prior to the procedure.” “Though other states have passed similar measures requiring women to have ultrasounds, Oklahoma’s law goes further, mandating that a doctor or technician set up the monitor so the woman can see it and describe the heart, limbs and organs of the fetus. No exceptions are made for rape and incest victims,” the New York Times observed.

Similarly, the Florida state senate just voted 22-17 “in favor of a new government mandate that women seeking abortions must pay for ultrasounds — which averages from $200 to $1,000 — and, in most cases, view live images of the fetus.” “They also adopted an amendment banning abortion coverage for individuals and businesses who buy insurance under insurance exchanges.” The bill is set for a final vote Thursday in the Senate and will then move to the “deeply conservative” House.

For more on this wave of new abortion restrictions, click here.

Gov. Arnold Schwarzenegger (R-CA), who had previously described national health care reform as “health care to nowhere” that’s infected with “bribes, deals and loopholes,” is expected to announce today that California will fully comply with the new law. According to an advance copy of a speech obtained by the AP, the governor will call on lawmakers to set politics aside and “start implementing the law.” “If reform is to succeed, he says, it is up to the states to make it happen.” Schwarzenegger’s endorsement will make him the first Republican governor to publicly support health reform, delivering a major victory for HHS Secretary Kathleen Sebelius, who been trying to portray the law as beneficial to the states. The governor’s support also comes as Republicans across the country are distancing themselves from reform, suing the federal government, and refusing to implement its early provisions.

Over at California Healthline, Kate Ackerman runs down how residents could benefit from the new law:

- Effective Immediately — Small Business Tax Credits: According to a March issue brief from UC-Berkeley’s Center for Labor Research and Education, California residents who work at small businesses or are self-employed represent a disproportionate 71% of the state’s total uninsured population. The center estimates that small California businesses could receive more than $4.4 billion in tax credits over 10 years through the reform provision.

- April 1, 2010 — Medicaid Expansion Option: By Jan. 1, 2014, states are required to expand Medicaid eligibility to non-elderly residents with incomes less than 133% of the federal poverty level. However, the reform law allows states as of April 1, 2010, to phase in the Medicaid expansion to take advantage of federal matching dollars…. California and other states that face significant budget shortfalls are unlikely to expand their Medicaid programs before 2014. California officials have estimated that it will cost the state $2 billion to $3 billion more each year to cover new Medi-Cal beneficiaries.

- Effective 90 Days After Enactment — High-Risk Pools: California already has a high-risk pool — the Major Risk Medical Insurance Program — but it does not meet the requirements of the new health reform law because it caps enrollment at 7,100 and insurance benefits at $75,000 per year because of limited funding. The federal high-risk pool under the reform law calls for subsidized premiums and no annual caps on benefits. A bill (AB 1887) by Assembly member Mike Villines (R-Clovis) would establish a new high-risk insurance pool that would operate alongside MRMIP until 2014, when health plans will be prohibited to deny coverage to individuals because of pre-existing conditions.

- Effective Six Months After Enactment — Extending Coverage for Young Adults: UCLA’s 2007 California Health Interview Survey found that 29.5% of Californians ages 23 (when most health plans stop covering dependents) through 25 were uninsured. Some health plans, including California giant Kaiser Permanente, have announced that they will comply with this reform provision before it takes effect in September.

- Effective Six Months After Enactment — Prohibiting Pre-Existing Condition Exclusions for Children: The reform law prohibits health plans from excluding coverage to children with pre-existing conditions. By 2014, this provision will apply to all individuals. Assembly Member Mike Feuer (D-Los Angeles) has introduced a bill (AB 2244) that would go beyond the federal health reform provision by also limiting discriminatory changes for children with pre-existing conditions.

In 2007, Schwarzenegger unsuccessfully attempted to reform California’s health care system. Much like the new national law, his plan would have required Californians — even illegal immigrants — to purchase health insurance coverage, mandated businesses with 10 or more employees to offer insurance or pay a fee and expanded public health programs. Schwarzenegger’s proposal would have prohibited insurers from denying coverage to individuals with pre-existing conditions and required companies to spend at least 85% of their premium proceeds on patient care.

Earlier this month, Rep. Henry Waxman (D-CA) abruptly canceled hearings to investigate whether ending the deductibility of the retiree drug subsidy would cost employers billions of dollars. Without missing a beat, the Daily Caller’s Jonathan Strong and House Republicans are speculating that Waxman called off the much-publicized event to suppress embarrassing internal documents revealing that the health care law may cause employers to drop their existing health care coverage:

Publicly, Waxman said the investigation showed the companies’ disclosures were properly filed. But a new report from committee Republicans reveals the documents Waxman obtained included embarrassing evidence that the health-care law could drive up insurance premiums and force employers to dump employees from their health plans.

“Turns out Obamacare means if you like your health plan you can lose it. The president didn’t have to actually strong-arm companies into dumping their employee health insurance because his bill carried financial incentives to virtually guarantee that result,” Energy and Commerce Committee ranking member Rep. Joe Barton, Texas Republican, said. Most significantly, documents unearthed by the investigation highlight companies that are considering dumping employees from their current health-care plans in the face of new costs from the health-care law. President Obama repeatedly promised his health-care law would let Americans keep their current insurance if they’re happy with it.

Two things. First, if the Democrats were really interested in phasing out employer-based coverage, they would have adopted the Wyden/Bennett reform framework, which cuts the umbilical cord between worker, employer, and health care coverage. Secondly, if Republicans were interested in preserving the employer based system they would have supported a strong employer mandate to offer coverage (and their own health reform plans would reflect this). Instead, they spent the duration of health care reform arguing that requiring employers to provide health coverage would lead to dramatic job losses and drive companies out of business.

As for the actual substance of Barton’s claim — it’s overblown. The new health reform law may gradually ween us off our dependence on employer-based coverage as employees of larger companies will eventually be given the option of enrolling in a state-based exchange. But this will happen incrementally and inconsistently. Large employers want to continue offering benefits and for the foreseeable future, they probably will.

The real argument in the retiree benefit rebate debate, however, has always been two fold 1) are insurers actually losing billions and billions of dollars (those same documents that Barton was reading from tell us that they’re not) and 2) will eliminating the deductibility of the retiree credit cause employers to dump retirees into Medicare Part D? According to, Medco Health Solutions, a pharmacy benefit manager, this too is unlikely.

The “most likely choices for a large percentage” of companies was to stick with their current retiree drug plans, despite the less-attractive tax treatment, or to switch over to something called an employer group waiver plan, which signs up retirees for the Medicare benefit as a group and is typically administered by an insurer or PBM. “David B. Snow Jr., Medco’s chief executive, said in an interview that “the majority of the customers feel a sense of [having made a] promise that they don’t want to break” by dropping retiree benefits. “Will some do that? Probably,” he said. “I definitely don’t think it’s the majority.”

Nevada Gov. Jim Gibbons (R)

Nevada is the third state to officially opt-out of the interim high-risk pool program put forward in the new health care law, paving the way for the federal government to enroll uninsured state residents in a federal high risk pool program. The health care law established the pools as an interim measure to provide coverage for Americans with pre-existing conditions until the exchanges become operational in 2014. States that fail to build upon their existing programs or establish new pools will cede control to the federal government. Georgia does not currently operate such a program.

In a letter to HHS Secretary Kathleen Sebelius, Gov. Jim Gibbons (R) blamed the feds for not providing enough money for the pools:

In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius, Gibbons said the estimated $61 million Nevada would receive to implement the pool under the recently signed federal health reform bill would be “grossly inadequate” to serve as many as 100,000 people who may be eligible.
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“We estimate Nevada’s share of the $5 billion national pool will only allow approximately 2,900 individuals to be served,” Gibbons wrote, adding that more than 500,000 Nevadans are uninsured and an estimated 100,000 may be eligible to join the pool. “We do not believe financial or human resources are available to manage the pool,” the governor wrote. “There will be a significant problem managing the few who become eligible, but an even larger problem managing the frustration of people not eligible for the pool.”

Gibbons isn’t wrong to argue that the federal government will probably need to put more money towards the program, but the sentiment seems to contradict the often repeated Republican claim that the federal government should stay out of the health care business altogether. In fact, the three other states that have chosen not to build their own pools or embellish their existing programs — Georgia, Louisiana, and Nebraska — have all portrayed the federal health care law as a grotesque abuse of federal power. Earlier this month, Gibbons even signed an “executive order appointing a Las Vegas attorney to represent Nevada in a multistate lawsuit filed in Florida challenging the constitutionality of the law after Democratic Attorney General Catherine Cortez Masto refused.” Now, he’s relying on the federal government to cover the uninsurable population, helping bring about the very thing he fears — greater government involvement in the health care sector.

Sen. John McCain (R-AZ) initially proposed state-based high-risk pools as a way to cover Americans with pre-existing conditions during the presidential campaign (conservative organizations like the Heritage Foundation seem to support the idea as well) and was heavily criticized by Democrats for underfunding the initiative. Now that Obama has accepted the idea into health reform, Republicans are taking their swings and opting out of McCain’s idea.

States have until Friday to tell the federal government if they will voluntarily establish or build upon an existing state-based high-risk pool program.