Kentucky and other states slow to adopt health-law mandates

Though it's one of the centerpieces of the new health care law, most states have not taken steps to establish a health insurance exchange, and that incluides Kentucky. The exchanges are meant to make it easier and less expensive for people who buy their own coverage to compare health plans.

"So much of this stuff is speculation," state Rep. Tom Burch (D-Louisville) told The Washington Post when asked why the state has not moved to set up an exchange. He said his party was "simply waiting for the Obama administration to issue regulations spelling out federal requirements in more detail." Burch is chairman of the House Health and Welfare Committee.

Despite a deadline of January 2013 to prove to the federal government they are getting ready to establish the exchanges, just seven states have adopted laws that outline the details of them. Two others, Virginia and North Dakota, have adopted legislation showing intent to form an exchange. Seven more states have not passed any legislation that pertains to an exchange, but have accepted grants meant to prepare for them. More than 10 states have defeated or haven't acted on proposed bills to establish exchanges. About 13 other states haven't even broached the matter on their committee floors.

States also seem to be grappling with an impending Medicaid deadline. Because the new health-care law expanded the income guidelines for Medicaid eligibility, states will have to provide care for a broader range of Americans starting in 2014. But a report by the National Governors Association and the National Association of State Budget Officers shows that states are struggling to pay for the program as it is now.

The report shows 43 states have passed laws to contain Medicaid costs, and nearly half of the states have reduced payments to physicians, hospitals and other health-care providers. More than 20 have agreed to lower spending on prescription drugs, and 20 have restricted some services. For the coming year, "45 governors proposed further cuts, the report says, without specifying which reductions were adopted by legislators," Goldstein and Aisenman report. (Read more)

Kentucky legislators grappled in a special session to fill a $166 million gap in Medicaid funding this year, and the state is turning to managed-care organizations to run the program.