cloudy-day Created with Sketch.
Scattered Clouds
H 94° L 71°
  • cloudy-day Created with Sketch.
    Current Conditions
    Sunny. H 94° L 71°
  • clear-day Created with Sketch.
    Sunny. H 94° L 71°
  • clear-day Created with Sketch.
    Sunny. H 94° L 71°

The latest top stories

00:00 | 00:00


The latest traffic report

00:00 | 00:00


The latest forecast

00:00 | 00:00

Obama win boosts health law, but states still control its destiny

President Barack Obama’s re-election ensures the survival of his landmark health care law, but predominantly Republican state officials will get a big say in how it is carried out.

State lawmakers will control whether millions of uninsured people get coverage through Medicaid beginning in 2014, as the law envisions. They’ll also decide whether to set up online markets where individuals can shop for coverage and seek federal subsidies to lower their costs.

Next year, at least 30 states will be led by Republican governors, and many will also have Republican-controlled legislatures. Still, most analysts believe the president’s victory will prod the nearly three dozen states --both Republican and Democratic -- that have been reluctant to move forward.

“Red states and undecided states [will] reconsider what they have been saying and doing the past few months,” said John Poelman, senior director of Leavitt Partners, a consulting firm advising states on carrying out the law, citing pressure from consumers, hospitals and other providers to expand coverage.

States have considerable sway over how the law is carried out because the Supreme Court gave them the power to reject the expansion of Medicaid, which had been expected to cover more than half of the 30 million people gaining health insurance under the law.

Since the court’s decision, six Republican governors in Texas, Florida, Mississippi, South Carolina, Louisiana and Georgia have said they will not participate, even though the federal government would cover the costs of new enrollees through 2016 and at least 90 percent thereafter.

If those governors follow through, they could significantly undermine the law’s goal of extending coverage to uninsured Americans.

Most analysts are betting that won’t be the case, however, because billions in newly available federal subsidies and intense lobbying by health providers and consumers will spur most states to reassess their positions. The most recalcitrant, such as Texas and Florida, may opt out initially.

“Not all states will expand Medicaid in 2014, but within a couple of years, all of them will have,” Poelman predicted. “That’s similar to what happened when Medicaid began in 1965. The program did not start in every state initially, but nearly all had it by 1970. Arizona was the last state to add the program in 1982.”

State Lawmakers Weigh In

State lawmakers will also play a key role in deciding whether to expand Medicaid when they convene this winter and next spring.

“When state legislatures are back in session, we expect a flurry of attention to what the states will do,” said Richard Cauchi, health program director for the National Conference of State Legislatures.

Mike Fasano, a Republican and one of the longest serving Florida lawmakers, said with the president’s win, the GOP-dominated state legislature would “take a hard look” at expanding Medicaid -- despite the opposition of Republican Gov. Rick Scott.

Fasano, who is moving from the state Senate to the state House next year, said Florida can’t afford to miss out on new revenue without having its own plan to help more than four million residents who lack health insurance.

He acknowledged that challenging Scott would be an uphill battle but said the governor’s waning popularity might embolden lawmakers.

Officials in other states insist they will opt out of the Medicaid expansion regardless of the election outcome. “An Obama victory won’t change our strategy,” said Tony Keck, Medicaid director of South Carolina, although he acknowledged it might spur questions from the Republican-controlled state legislature.

Keck said the only way state officials might consider expanding the program is if they can scale back eligibility and benefits and require Medicaid recipients to pay more for their care --- requirements the Obama administration has generally opposed.

Sandy Praeger, Kansas’ insurance commissioner and past president of National Association of Insurance Commissioners, expects many states to attempt to negotiate smaller Medicaid expansions than called for in the law.

Some, for instance, might propose expanding coverage to people who make up to 100 percent of federal poverty level ($23,050 for family of four), instead of the 133 percent ($31,000 for a family of four) required by the law. A more limited expansion would be cheaper for states that will have to start paying some of the bill in 2017. The administration has yet to say whether states can do a partial expansion.

Deadlines Loom On Exchanges

The first battles are likely to be over the health law’s new insurance exchanges, which are supposed to make it easier to find an affordable plan and to help people in small group and individual insurance market determine if they qualify for new federal subsidies.

States have to give federal regulators a plan by Nov. 16 detailing how they will move forward with their own exchanges, with enrollment slated to launch next October. Under the law, the federal government would set up exchanges where states don’t.

As of late September, only 19 had begun setting up exchanges or agreed to do so in partnership with the federal government, according to an analysis by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.) 

“It certainly will matter who is in the governor’s office for how states will approach the decision” on exchanges, said. Alan Weil, executive director of the National Academy of State Health Policy.

He noted the after Republican governors won in Maine and Wisconsin in 2011, both put the brakes on efforts to implement the law, which had been started by their Democratic predecessors.

But some governors who are worried about the costs are also concerned that if the federal government steps in, they may lose control over their insurance markets, said Krista Drobac, director of the health division at the National Governors Association.

Whether states that have stood on the sidelines until now can meet the tight deadlines to have the exchanges running by late next year is an open question. That timeline is also likely to be a challenge for the federal government which will have to review hundreds of insurance plans if it sets up the marketplaces in dozens of states. Consumers in federally operated exchanges may initially have fewer choices than in those run by states.

Praeger expects that Kansas and other previously undecided states will agree to partner with the federal government to move forward.

“I expect to see a lot of activity between now and Nov 16,” she said. “States will look at this more pragmatically to keep their options open.”

Read More

There are no comments yet. Be the first to post your thoughts. or Register.

The Latest News Headlines

  •  The Jacksonville Sheriff's Office is investigating after a customer shot an employee in the leg at the Popeyes Louisiana Kitchen on Edgewood Avenue. Police said there were four employees in the store at the time of the shooting. The employee who was shot has non-life-threatening injuries. The suspect fled in a black truck after the shooting, police said  JSO is working to get surveillance video. 
  • United Airlines will no longer allow crew members to bump passengers already on board flights after facing heavy criticism for its removal of a Kentucky physician earlier this month. >> Read more trending news The policy change came after video surfaced on social media of officers with the Chicago Department of Aviation dragging Dr. David Dao off Flight 3411 after he declined to relinquish his seat to make room for a crew member. Dao’s attorney said last week that the confrontation left Dao with a broken nose and a severe concussion. Two of his front teeth were knocked out and he was hospitalized for three days. >> Related: United passenger suffered broken nose, teeth while being dragged from plane The change was outlined in an internal email on April 14, The Associated Press reported. Crew members are required to make “must-ride bookings” at least an hour before the flight is scheduled to leave, according to the AP. The airline previously allowed crew members to make bookings until the time of departure. A spokesperson for United confirmed the policy update to NPR, saying it “ensures situations like Flight 3411 never happen again.”  'This is one of our initial steps in a review of our policies in order to deliver the best customer experience,' the spokesperson told NPR. >> Related: Delta will now pay passengers up to $9,950 to give up seats United is not the only airline that has adjusted its policies in the wake of the dragging incident. Delta Air Lines updated its financial incentive policy to offer up to $9,950 to passengers who volunteer to give up their seats on overbooked flights. American Airlines changed its conditions of carriage and said it would not “involuntarily remove a passenger who has already boarded,” The Washington Post reported.
  • A Facebook Live video led police to a suspect in the December 2016 death of a woman in a Pittsburgh, Pennsylvania, neighborhood.  >> Read more trending news Isaiah Booker, 23, of Homestead, was charged Tuesday with criminal homicide, criminal attempted homicide, aggravated assault and persons not to possess a firearm.  The charges stem from the shooting death of 25-year-old Myanne Redman, who was found Dec. 19 in her car on the 2200 block of Wilner Drive.  Redmen left behind three young children, including a 1-year-old. Booker is the father of the 1-year-old child, police said.  Investigators said they identified Booker as a suspect after he posted a Facebook Live video nearly two months after Redman was shot to death. Gunshots can be heard in the video and a police officer is heard yelling 'Stop.
  • The Duval County School board looked over more than 140 recommendations for cuts to their budget and of those only 74 were deemed feasible. Of the 74 cuts that are possible, some of those didn't sit well with members of the board.  Some of those included cuts to art programs, athletics, and even field trips.  In regards to cuts in those fields, board member Betty Burney says, 'Cutting the arts and physical education opens the door to students going to private schools.' Board Chairman W.C. Gentry, after reviewing the recommendations, admitted those weren't enough.  Even if they accepted all of the 144 cuts that would only save them $30-million, their budget deficit is close to $100-million.The chairman and other board members acknowledge they'll have to consider drastic measures for the upcoming budget year.  They're considering cutting the school week down to 4 days and adding an hour to each day.Before some changes to state law the school board used to be required to complete 180 days in a school year, now they have to complete enough hours to match 180 days so that would allow them to make the change to 4 day school weeks.They'll also look into furlough days for teachers, as many as 20.  Twenty furlough days would equal an estimated savings of $50-million according to the chairman.Because the county is so strapped for cash, the chair says they're going to have to consider everything.  Duval is looking at a 5-6% budget cut, at least.From today's meeting, they will look into how much they could save with 4 day school weeks, what's the minimum number of tests they can take some schools are taking up to a dozen tests that can cost as much as $65 per student.They'll look into cutting transportation costs for magnet school students - last year that cost the district more than $50 million.The board will also look to see how much they can save by completely eliminating athletics across all schools.In closing to the budget workshop, the chairman says they might want to consider litigation.  Right now a major problem in the district, along with the underfunding for instructional hours is the fact that they have to comply with class size requirements.  They would be able to balance the budget with larger classes through consolidation and other methods but because they can't do so without being noncompliant they might join other pending lawsuits against the state.The district is still working to submit a plan to the state on its four intervene schools. The last plan had been rejected earlier this month.
  • The jury that will sit over the federal fraud trial of now-former Congresswoman Corrine Brown has been chosen. Seven men and five women are on the panel. Four alternates have also been chosen- not two as the initial court order stated. The alternates will not be told they are alternates ahead of the trial, instead, they’ve been mixed in among the others and the group is sitting as a body of 16.  CONTINUING COVERAGE: The trial of now-former Congresswoman Corrine Brown US Magistrate Judge James Klindt, who presided over the two-and-a-half day selection process, says they sat four alternates because of the anticipated length of the trial- at three weeks.  By the observation of our reporter in the courtroom, the 12 person panel appears to be three white females, five white males, two black females, one black male, and one Hispanic male. Nine of the jurors live in Jacksonville, one in Bunnell, one in Middleburg, and one couldn’t be determined by our reporter because it was not clearly stated by the juror.  The defense was allowed to make ten strikes “without cause” and the prosecution had six, but neither side used all of those strikes before agreeing on the panel.  US District Judge Timothy Corrigan- who is presiding over the trial- took the bench for the first time just ahead of 11:15AM Wednesday, had the jury sworn in, and then issued instructions to the panel.  The instructions included reinforcing that the jurors cannot speak to anyone about the case, and that none of the parties involved in the case should be approaching them through the trial itself. The jury will not be sequestered, but has been repeatedly instructed not to seek out any news reports about this case or discuss the case with anyone.  “Our whole system depends upon the fact that this case is decided in this courtroom on the evidence in this courtroom, and nothing else,” Corrigan told the jury.  Corrigan further started to explain the prosecution’s burden to prove “beyond a reasonable doubt”, and that there is no obligation on the defense to prove anything. Jurors will be given notepads and paper during the trial, but those are taken from them at the end of the day every day.  JUROR DETAILS:  Juror 1- black male from Jacksonville, high school education, single and never married. He works in merchandising for a soda company. He served on a criminal jury in state court about ten years ago, and they were able to reach a verdict. This juror said he had some prior knowledge of this case from watching the news, but had no more details than the case statement delivered by Klindt and had not formed any opinion on guilty or innocence. Two of this juror’s cousins and two of his friends have been arrested- a cousin was arrested in the 1980s and did 27 years for drug possession, a cousin was locked up in the 1980s for a robbery, a friend was arrested for murder in 1993 and sentenced to life in prison, and another friend was arrested for molestation in the last five years. This juror says these cases wouldn’t influence him, because the people involved were guilty and he would be able to set those cases out of mind to focus on these proceedings.  Juror 2- white male from Jacksonville, high school education with some college, married with one 23-year-old child. He works in sales and his wife is a homemaker. He has been a juror on a criminal case in state court, and they did reach a verdict. This juror said he had met Brown once in the past when he got the chance to be in a luxury box his company owns, but that meeting does not influence how he views Brown.  Juror 3, who was identified in jury selection as Juror 9- black female from Jacksonville, associates degree, divorced with two children- a 4-year-old and a 9-year-old. She is recently unemployed, but previously worked as a registration analyst for a mortgage company and leasing agent at an apartment complex. This juror was a victim of a crime by her ex-husband, with the details of that crime being discussed during a private sidebar with the judge and attorneys.  Juror 4, who was identified in jury selection as Juror 12- white male from Bunnell, high school education, divorced with a 30-year-old son. He was a factory worker and previously served four years in the Army. This juror said he had some prior knowledge of this case based on a comment his sister-in-law made when he received a jury summons, but he had not otherwise paid attention to the case nor did he have an opinion about it. This juror’s brother was arrested in the 70s after drunkenly shooting up a man’s car in a retaliatory act, but he says that wouldn’t influence him because he didn’t follow the case closely since he was serving in Korea.  Juror 7, who was identified in jury selection as Juror 13- white male from Jacksonville, Bachelor’s degree in Communications, married. He is currently a hair stylist and his spouse is with an insurance group. This juror said he has some knowledge of the case because he watches the news nightly and he is active on social media, but he hasn’t formed an opinion on the case because he hasn’t looked in to it in depth.  Juror 8, who was identified in jury selection as Juror 17- white female from Jacksonville, high school education with some college, widow. She is a real estate property manager. She was a juror in a criminal case in state court in 2014, and they were able to reach a verdict.  Juror 9, who was identified in jury selection as Juror 19- black female from Jacksonville, Bachelor’s degree in Respiratory Science, married with one son. She served in the Navy for 21 years and her husband is retired Navy as well. She now works in the respiratory science field. This juror’s brother was tried and convicted of attempted manslaughter in the early 80s. She says her family doesn’t talk about it, so she hasn’t formed any opinions about it.  Juror 10, who was identified in jury selection as Juror 23- white female from Jacksonville, Bachelor’s degree in Business, married with three children. Her children as a 26-year-old waiter, a 23-year-old who works in a grocery store, and an 18-year-old graduating high school. She works in sales support for an insurance company and her husband grades essays for standardized tests. She served on a jury in a state criminal case in Indiana, and they were able to reach a verdict. This juror said she had some prior knowledge of the case because she reads the paper daily, but she stopped reading any articles about the case when she received her summons about a month ago. She did not have any opinion on the case.  Juror 13, who was identified in jury selection as Juror 26- white male from Middleburg, high school education with some college, married with three daughters- a paralegal, a waitress, and one who does financial work in the medical field. He is unemployed, but previously worked for a mortgage investor company. He has prior military experience of 13.5 years at Cecil Field.  Juror 14, who was identified in jury selection as Juror 35- white female from Jacksonville, high school education with some college, married with two kids- a 13-year-old and a 19-year-old college student. She is a service consultant for an insurance company and her spouse is self-employed in landscaping. This juror says she has some prior knowledge of the case, but only that she had heard on the news that there was a trial.  Juror 15, who was identified in jury selection as Juror 39- white male, Associates degree, single. Works for the Department of Transportation. This juror says he has some prior knowledge of the case from watching the news, but hadn’t heard many specifics. Friends had joked that he could potentially be on the jury, but it’s nothing that led him to form an opinion. This juror has a family member that worked for a county sheriff’s office, but that has no impact on how he views law enforcement.  Juror 16, who was identified in jury selection as Juror 40- Hispanic male from Jacksonville, Bachelor’s degree in Network Technology, married with three children- a 33-year-old case manager with DCF, a 31-year-old in the armed forces, and a 25-year-old in college. He works as a shift supervisor at a youth camp in Starke and his wife is a school teacher. He served 44 years in the military.  ALTERNATE JUROR DETAILS:  Juror 5, who was identified in jury selection as Juror 44- Hispanic male from Jacksonville, Bachelor’s in Communications, married with an 11-month-old daughter. He works as a Continuity Director with a media group and his wife owns a bed-and-breakfast. This juror says he knows one of the prospective witnesses, John Delaney, from having served as Vice President of UNF’s student government, but that was about seven years ago and it would not influence the weight and consideration he gave to Delaney’s testimony.  Juror 6, who was identified in jury selection as Juror 50- female of apparent East Asian descent from St. Johns County, high school education and some college, married with three children- one is a former Marine and current firefighter, one is a Marine, and one is a student. She has previously worked in account receivables, merchandising, and as a youth service worker. This juror says she has some prior knowledge of the case from watching the news daily, but she mostly consumes traffic and weather and had only heard generally about this trial. She has not formed any opinion and will weigh only the evidence presented at trial.  Juror 11, who was identified in jury selection as Juror 51- white male from Palm Coast, Masters in Business Administration, married with three children- ages 13, 11, and 6. He is a medical surgical rep and his wife is a homemaker. He served on a criminal jury in a case in Flagler County four years ago, and they reached a verdict.  Juror 12, who was identified in jury selection as Juror 52- black female from East Palatka, high school education with some college, divorced with one 41-year-old son who’s a bus driver in New York. She is a lab analyst. She has previously served on a jury on a state criminal, but the case settled. This juror says she has some prior knowledge of the case from seeing a little on the news, but she hasn’t discussed the case with anyone, nor has she formed an opinion. This juror answered affirmatively that she, a close friend, or family member had been arrested for a crime, but the specific details were discussed in a private sidebar with the judge and attorneys.

The Latest News Videos