Capitol to Capitol
An Information Service of NCSL's Standing Committees

Volume 17   Issue 17- May 6, 2010


Throughout last week, House and Senate leaders continued to indicate their intent to finish H.R. 4213, which would give states an additional six months of the ARRA enhanced Medicaid match before the Memorial Day recess. Progress remains slow as members continue to search for offsets for some of the bill’s provisions, namely those extending a variety of expired tax credits and deductions. Also impeding progress are efforts to extract provisions from other “jobs” bills, namely efforts to expand the Build America Bonds programand include them in H.R. 4213. Senate leaders also continue to insist they will get to H.R. 4849 by the same recess. H.R. 4849 would give states one more year of funding for the ARRA Temporary Assistance for Needy Families (TANF) Emergency Contingency Fund and for assistance to small businesses. State legislators should continue to press their delegations to support the FMAP and TANF provisions. (NCSL staff contacts: Michael Bird, Jeff Hurley (jobs bills generally), Joy Johnson Wilson, Rachel Morgan (Medicaid), Sheri Steisel, Lee Posey (TANF))


U.S. senators will spend most or all of May debating S. 3217, legislation that would reform the nation’s financial services regulatory framework. Like its House-passed counterpart, S. 3217 would impede the states’ abilities to regulate the business of insurance just as states undertake implementation of federal health care reform legislation and its insurance-related elements. The underlying legislation drew a stiff rebuke from NCSL in an April 22, 2010, letter signed by Georgia Senator Don Balfour and Rhode Island Representative Brian Kennedy, NCSL’s President and Chair of NCSL’s Committee on Communications, Financial Services and Interstate Commerce, respectively. The letter asserts that a new federal insurance office “would preempt state solvency regulations through its unilateral power to enter into international insurance agreements” and duplicate state regulatory efforts. NCSL also challenged the legislation’s intent to wrap insurance into a federal systemic risk component. Debate and votes on floor amendments start May 4, 2010. The NCSL letter can be viewed at (NCSL staff contacts: Neal Osten, Jeff Hurley)


An April 22, 2010, letter from the federal Centers for Medicare and Medicaid Services (CMS) to state Medicaid directors affirms that increases in prescription drug rebates will not be shared with states, with increases retroactive to Jan. 1, 2010, per enacted federal health care reform law. In the past, both states and the federal government have shared the rebates. These actions could jeopardize states’ ability to receive supplemental rebates above minimum levels as they do now. The letter also spells out expansion of prescription drug rebates “to covered outpatient drugs dispensed to enrollees of Medicaid managed care organizations.” More information is available on NCSL’s health care webpage, available at (NCSL staff contacts: Joy Johnson Wilson, Rachel Morgan)


States had until last Friday, April 30, 2010, to declare their intent to establish high-risk pools for currently uninsured individuals with pre-existing conditions or opt to have the federal government carry out a high-risk pool program for them. States deciding to run their own pools include: Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington, Wisconsin and the District of Columbia. States opting for the federal government to run these pools are: Alabama, Delaware, Florida, Georgia, Hawaii, Idaho, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia, West Virginia and Wyoming. Three states remain undecided: Arizona, Oregon and Utah. This issue will be addressed in detail during NCSL’s initial webinar on federal health care reform scheduled for May 9, 2010. HHS will issue preliminary regulations on the high-risk pool program for comment at the end of May. A fact sheet on the temporary high-risk pool program and a chart showing potential allocations of the $5 billion in federal funds designated for this program is also available on NCSL’s health care reform webpage. (NCSL staff contacts: Joy Johnson Wilson, Rachel Morgan)