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DELAWARE: In his State of the State speech, Governor Jack Markell emphasized the need for state government to spend more efficiently.  He specifically noted that the demands state employee health insurance and pensions are putting on the state budget are unsustainable. The Governor specifically stated he is open to any and all good ideas for addressing this budget issue. In other news, a joint meeting of the Senate Health Committee and the House Economic Development, Banking, Insurance, and Commerce  Committee was convened for an update on the state's effort to implement health care reform. Rita Landgraf, Secretary of Health and Social Services, along with Bettina Riveros, Health Care Commission Chair, advised legislators the commission will spend the next six to eight weeks holding stakeholder meetings across the state seeking input on establishing a state health insurance exchange.

GEORGIA: The Exchange Workgroup formed by former Governor Sonny Perdue had its final meeting last week and will submit a list of issues for Governor Deal's administration to review before deciding how to proceed on the issue of instituting an exchange in Georgia. As the head of this workgroup for Governor Perdue is continuing under Governor Deal's administration, it is likely that there will be some enabling legislation during the 2011 session, though it is unclear what that will be. The legislative session began January 11, 2011 and continues for 40 legislative days.

IOWA: The General Assembly convened in Des Moines on January 10 and is expected to adjourn on April 29, 2011  In the November elections, Republicans took control of the House and gained a few seats in the Senate, narrowing the Democrats' majority there. Republican Terry Branstad was sworn in as governor for the second time. Having served in the post from 1983 to 1999, Branstad is the longest-serving governor in Iowa's history. The state's budget deficit is projected to be more than $785 million for fiscal year 2012 and will dominate legislative discussions. House Speaker Kraig Paulsen has vowed to remedy the deficit through spending cuts rather than tax increases. The Governor's proposal to revise the state's annual budget to a two-year cycle will also be debated. Bills of interest so far include several challenging PPACA's individual mandate, a prohibition on abortion coverage, creation of mandate-lite policies, a mandate for coverage of smoking cessation programs, a rate review bill that would require a public hearing for any increase over 10 percent in the individual market, and a bill establishing $100 as the minimum required payment for state employees.

 INDIANA: Governor Mitch Daniels has issued an executive order  establishing the Indiana Health Benefit Exchange. In his order he directs the Indiana Family and Social Services Administration (IFSSA) to cooperate with appropriate state agencies, including the Department of Insurance (IDOI), to establish and operate the exchange. The IFSSA Secretary or the secretary's designee will serve as the incorporator of the Exchange. If, after careful analysis, the state deems it appropriate to proceed with creation of the exchange, a board of directors will be selected. The board will include representatives of state agencies and the Indiana General Assembly. Standing Committees will be appointed that have stakeholder representation. 

In addition, Governor Daniels submitted a letter to HHS Secretary Kathleen Sebelius requesting approval of a state plan amendment to extend the Healthy Indiana Program (HIP) beyond its expiration date. HIP, the state's consumer-directed program for covering the uninsured population, is scheduled to expire in 2012. Daniels notes he has received communication from HHS staff indicating the state plan amendment will be rejected due to HIP's required level of contribution from participants.  The Governor said the state intends to utilize the program for the newly eligible Medicaid population pursuant to PPACA. Daniels cautioned that Indiana does not have the time and financial resources necessary to complete new rigorous requirements for applying for a waiver extension if the amendment is rejected. The current 45,000 enrollees in the program would have to be transitioned into traditional Medicaid.

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