Ready for what’s next.
Council for Electronic Revenue
Communication Advancement (CERCA)
2011 Spring Meeting
Presented by Abby Block,
Senior Executive Advisor
May 26, 2011
© 2011 Booz Allen Hamilton Inc.
Discussion Topics
• 2010 United States gubernatorial elections
• Planning grants
• Early innovator grants
• Links between Health and Human Services (HHS) and the Internal Revenue
Service (IRS)
• Role of regulations
• Issues concerning data flow
• Taxpayer/consumer perspective
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2010 United States Gubernatorial Elections
November 2, 2010
39 Governorships
Party
Majority party
Minority party
REPUBLICAN
DEMOCRATIC
Last election 24 governorships
Seats before
Seats after
Seat change
23
29
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Republican gain
Republican hold
Democratic gain
Democratic hold
Independent win
No election
26 governorships
26
20
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The United States gubernatorial elections were held November 2, 2010, in 37 states (36 elections were
regularly scheduled, whereas a special election was held in Utah). Although Democrats did take five
governorships (in California, Connecticut, Hawaii, Minnesota, and Vermont) from Republicans, Republicans took
11 governorships (in Iowa, Kansas, Ohio, Oklahoma, Maine, Michigan, New Mexico, Pennsylvania, Tennessee,
Wisconsin, and Wyoming) from Democrats. An independent won one governorship (in Rhode Island) held
previously by Republicans, and Republicans won one governorship held previously by an independent (in
Florida). Thus, Republicans held a majority of governorships for the first time since before the 2006 elections.
Most gains were made in races in which no incumbent was running (because of either term limits or voluntary
retirement). Only two sitting governors were defeated for reelection: Democrats Ted Strickland of Ohio and Chet
Culver of Iowa.
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Planning Grants
• Originally, 48 states and the District of Columbia received planning grants
• Planning grants were $1 million each
• Alaska and Minnesota did not apply
• Florida, Louisiana, and Oklahoma are returning their grants and plan to opt out of
operating their own health insurance exchanges
• Minnesota is opting in
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Early Innovator Grants
• On February 16, 2011, HHS announced an award of seven cooperative
agreements to help design and implement an information technology (IT)
infrastructure needed for operating health insurance Exchanges, particularly with
respect to eligibility and enrollment systems
• Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a multi-state
consortium that the University of Massachusetts (UMASS) Medical School leads
will receive roughly $241 million; however, Oklahoma announced recently that it
plans to return its innovator grant
• Using grants, early innovators will develop models and building blocks for
Exchange IT systems. States may choose to use these models and building
blocks to establish their own Exchanges. States retain the flexibility to develop an
Exchange tailored to their unique health insurance market without having to start
from scratch
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Early Innovator Grants, continued
• The grantees are diverse in terms of region, governance structures, and
information systems, ensuring a wide range of IT models
• To ensure that Exchange IT systems are comprehensive, they must handle not
only eligibility and enrollment but also premium tax credits and cost-sharing
reductions for eligible consumers. Exchange IT systems also must be
interoperable and integrated with state Medicaid programs to allow for switching
from private insurance to Medicaid and the Children’s Health Insurance Program
(CHIP) as eligibility changes
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Links Between HHS and IRS
• Meetings of various work groups began as early as June 2010 and have
continued intermittently ever since. Information about interagency meetings is
being held closely
• The White House Office of Health Reform was coordinating the meetings at the
political level among all implementing agencies; however, that Office has now
merged into the Domestic Policy Council. Ms. Nancy Ann Deparle is now
Deputy Chief of Staff
• Although the agencies share overall goals, views regarding strategy, process, and
outcomes likely will differ and must be reconciled, which we can infer is ongoing
• The Office of Consumer Information and Insurance Oversight’s (OCIIO) move
from an independent agency to the Center for Consumer Information and
Insurance Oversight (CCIIO) within the Centers for Medicare & Medicaid Services
(CMS) changes the climate somewhat
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Role of Regulations
• HHS will publish regulations specifying requirements for Exchanges. Issuance
has been delayed, and the earliest anticipated date is now July but could move
into fall. A draft might already be at IRS for review.
• IRS should specify changes to tax schedules that the Affordable Care Act (ACA)
requires for implementation.
• HHS will want to give states maximum feasible flexibility.
• IRS likely will want to minimize changes to current processes.
• Details are still under discussion within and between agencies. Sensitivities are
acute, and details are being held closely.
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Issues Concerning Data Flow
• What data will be stored, and where will it be stored?
• How will data be accessed?
• Who will have access to the data?
• What information will be communicated among federal agencies and state
agencies? With Exchanges? With individual applicants?
With insurance carriers? With employers?
• What will be the timeframes for data exchange and transmission?
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Taxpayer/Consumer Perspective
• Outreach will occur at multiple levels (e.g., HHS, IRS, Exchanges, navigators)
• Application process could be challenging for some consumers, especially
applicants for a premium tax credit and cost-sharing subsidy.
• Tax filing requirements could be challenging for some taxpayers.
• Coordination among agencies responding to taxpayer/consumer inquiries will
be critical.
• Customer service representatives will need to be well informed and equipped to
help people navigate among the various agencies and organizations. Callers
could have multiple issues.
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