How to implement campus carry?

We'll have to deal with this soon as well. Here UT struggles with it.

- Click here for the story.

A strong majority of speakers at the University of Texas at Austin’s first campus carry forum on Wednesday night voiced concern about the contentious law that will allow licensed Texans to carry concealed handguns in campus buildings.

But since lawmakers didn’t allow public universities to totally opt out of campus carry – as private schools can – many of those opposed to the proposal focused more on imploring school officials to make classrooms and other specific areas gun-free.

“I’m here to say as emphatically as I possibly can: Guns don’t belong in classrooms,” said Joan Neuberger, a UT-Austin history professor. “Not in the hands of criminals. Not in the hands of responsible gun owners. Not in the hands of CHL holders.” That nuance signals the next phase of the campus carry debate, as UT-Austin and other four-year universities start to get a handle on how they will implement the law in fall 2016.

Public university presidents have the ability to declare parts of campus, but not all of it, off-limits to gun. But it remains an open question of how much discretion the schools have, given that the law says only that the gun-free zones must be “reasonable.”

And town hall meetings – attended at UT-Austin by several dozen students, faculty, staff and graduates – are a critical step that several schools are now taking to gather feedback before making some preliminary recommendations likely by the end of the year.

“We are here to listen,” said Steven Goode, a UT-Austin law professor who’s leading the school’s campus carry working group.

Existing state law allows individuals with concealed handgun licenses to carry their firearms onto university grounds. But expanding that right to dorms, classrooms, cafeterias and other public campus buildings was a priority for pro-gun Republicans.

Campus carry ended up joining open carry as the major gun bills passed this year. Though open carry uses existing concealed carry law as its basis, lawmakers made it so licensed Texas still won’t be able to openly carry handguns on campus.

From Wonkblog: Obamacare starts in 100 days

A little less actually since this was posted on June 23rd, its set to start up October 1st:

There are, arguably, two big things that need to happen between now and October. The first is technical:

The federal government needs to finish building the infrastructure that allows multiple government agencies to transmit information, determining whether an individual should qualify for tax subsidies. This is a really big lift that means connecting Health and Human Services, Treasury, Homeland Security and other agencies in a way that has never really happened before.

Also in the technical arena, the federal government needs to finish building the federal exchange, an online portal that most states will have their residents use to purchase health insurance. Fifteen states are also in the midst of putting finishing touches on the insurance markets they opted to run.

“It’s a compressed time frame,” says Kevin Walsh, a top executive at Xerox, who has worked extensively on Nevada’s health insurance exchange. “We are working diligently to implement the entire scope of work for October 1. So, you back up from there. It means we have to have all our enhancements done in mid-July, so we can do the integration testing.”

A few months ago, Walsh gave me one of my favorite charts on the health insurance exchanges, which explains why this technology piece is such a big lift for state and federal governments.

From outreach to eligibility determinations to bringing health plans into the marketplace, all of that needs to be ready by Oct. 1.

There’s one other task on the Obama administration’s plate just as big as technological work, and that’s outreach. Even if the technological launch goes off without a hitch, that won’t be much good if no shoppers show up to the marketplace.

To that end, non-profit Enroll America last week launched its education and enrollment campaign. The group started shortly after health reform became law. And their goal is, come October, making it impossible for an uninsured person not to know that there are new options available.

“If I’m uninsured and it’s October, I won’t be able to go anywhere without escaping a message,” John Gilbert, who leads Enroll America’s field operations, told supporters in a Thursday night presentation. “I turn on my TV and there’s an ad. I go on the Internet and there’s another ad. Someone shows up at my door to talk about it. I go to church and my pastor is talking about it.”

From the Hill: 10 to watch on ObamaCare rollout

The Affordable Care Act is going through the implementation phase of the public policy process.

Time to get caught up. Here's The Hill's look at the major players in the process.

Here's one:

* Andy Allison (Arkansas Medicaid Director)

Allison has been called a visionary for his role in a proposal to use funding from ObamaCare’s Medicaid expansion to finance the purchase of private coverage for low-income people on the state’s insurance exchange. The plan is seen as a possible red-state alternative to the expansion and has been approved both by federal health officials and the Arkansas state legislature. It’s also expected that the plan could lower premiums on the exchange and draw in new insurance carriers.

Allison moved the Arkansas Medicaid program away from fee-for-service payments and toward a model that rewards quality and efficiency. He formerly served as head of Medicaid in Kansas, and started his work in the field as a Medicaid analyst at the Office of Management and Budget.

Health Insurance Exchanges underway in California

The implementation of Obamacare continues. California has a head start and there are indications that costs might be lower than anticipated. 

Texas - not so much.

Click here for the timeline.

Texas will not set up an insurance exchange

No surprise here. Story in the Houston Chronicle:

A day before a Friday deadline, Gov. Rick Perry announced Texas would not set up a key component of the Affordable Care Act, a health-insurance exchange that would allow individuals and small businesses to find coverage online at the most favorable price.

The governor reiterated his opposition in a letter released Thursday to U.S. Health and Human Services Secretary Kathleen Sebelius.

"As long as the federal government has the ability to force unknown mandates and costs upon our citizens, while retaining the sole power in approving what an exchange looks like, the notion of a state exchange is merely an illusion," Perry said in the letter. "It would not be fiscally responsible to put hard-working Texans on the financial hook for an unknown amount of money to operate a system under rules that have not even been written."

The health insurance exchanges are the primary means for individuals to purchase health insurance under the ACA (Obamacare). each state is allowed to establish its own exchange if it chooses, but has to have this done soon - the deadline has been adjusted recently. These have to operational by January 1, 2014. If a states chooses not to do so, the federal government can step in to set it up. 

The TSA's Pat Down Policy

Slate outlines the process by which the pat down policy was developed, announced and implemented, as well as the campaign its now waging to defend it. It creates and interesting dilemma for both the TSA and the Obama Administration. Which woudl you rather have to explain? Why travelers were groped, or why you let an explosive on a plane, especially if it goes off?

While we're at it, here's something to relax about: cavity bombs. Current technonoly cannot detect them.

Implementing Health Care Reform

With apologies to the National Journal, I copied and posted a recent piece detailing the issues associated with implementing the recently passed health care legislation.

Writing The Rules For The Health Law: The new law offers some benefits this year, but a quick turnaround on writing regulations could prove difficult.

by Marilyn Werber Serafini
Saturday, May 1, 2010

The Obama administration faces a monumental task this year in implementing the first changes dictated by the new health care reform law, not to mention laying the groundwork for the bigger changes to come in 2014.

On the political front, meanwhile, Obama and his team have a challenge in selling the public on health reform's benefits before November's congressional elections. Surveys show that opposition has grown since the law was enacted on March 23, with various April polls finding 40 to 54 percent of respondents unhappy. The White House announced last week that Stephanie Cutter, who handled the president's nomination of Sonia Sotomayor to the Supreme Court and advised first lady Michelle Obama on her childhood obesity initiative, will spearhead the effort to bolster public understanding of and support for the reforms. (See "Winning the Perception Game," NJ, 4/24/10)

Democrats wrote the law so that some of its most appealing reforms come this year -- a good strategy so long as those changes happen smoothly and on time. "The major benefits of the law -- the coverage expansions, subsidies, and insurance market reforms -- do not kick in until 2014," Drew Altman, president of the Kaiser Family Foundation, wrote on the foundation's website. "To compensate for that, the architects of the legislation built in a long list of early deliverables so the public would see tangible and understandable benefits right away -- from allowing dependent children to stay on family policies until age 26, to beginning to eliminate the prescription drug doughnut hole for seniors."

These early reforms will help only a modest number of people, he cautioned, and premiums and out-of-pocket costs will continue to rise faster than wages. "So, on the one hand, the law might not provide the kind of help people are expecting in the first few years. On the other hand, the sky will not immediately fall, as many people seem to believe it might."
Altman predicted that few people will see any changes in the near term. "If the benefits and timetable for the law are communicated effectively, the expectations gap should be manageable; over time, the benefits the law provides will be highly valued by the American people, but it will be crucial to develop mechanisms to answer people's questions and link them to the benefits the law provides."

The Health and Human Services Department and other federal agencies are tasked with producing regulations for the changes that take effect this year. Nancy-Ann DeParle, director of the White House Office of Health Reform, is confident the administration can move quickly, although some observers predict missed deadlines.

The law provides $1 billion to help HHS implement the new law -- probably not enough, said Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution. As the Medicare administrator in the Bush administration, he launched the program's huge prescription drug benefit enacted in 2003. The Congressional Budget Office has estimated that HHS and the Internal Revenue Service will need $10 billion to $20 billion over 10 years to carry out health reform.

McClellan said that speeded-up hiring procedures helped him implement the drug benefit but added that HHS no longer has such authority. Even with that boost, he said, he needed six to nine months to get key staff on board, and he faced his share of criticism. As the program geared up, the media trumpeted stories of seniors who were turned away from pharmacies empty-handed because of confusion over coverage. The program's telephone help line sometimes kept frustrated seniors on hold too long and then provided incorrect advice. Still, McClellan was able to smooth the wrinkles quickly enough to earn good marks for the program in opinion polls.

The "biggest challenge coming up fast" for HHS, he said, is ensuring that states and the federal government meet a June 23 deadline for establishing subsidized high-risk insurance pools for the people who are hardest to insure. More than 30 states operate such pools, and they may enhance those programs or let the federal government step in.

Georgia's insurance commissioner last month announced that his state would let the feds take over. It will be much easier (and cheaper) if states build on their existing pools, said McClellan, who agreed with other health care experts that the $5 billion to fund the pools until 2014 won't be enough; that amount might not last even a year, he said. If the funding runs out, the administration will have to ask Congress for another appropriation. Conversely, if the money lasts, it would probably signal that the pools are reaching too few people.

"Insurance availability for people who can't get it now is expected to be a high-profile issue," McClellan said. "If programs are not working, then that would confirm some views of the critics and create momentum for change. On the other hand, if the initial provisions go well and the administration can point to people who are benefiting, it keeps the overall package on track."

Also this year, Medicare beneficiaries who hit the so-called doughnut hole -- a gap in their prescription coverage -- will get a $250 rebate. Under the drug program, when spending on an individual has reached $2,250 on prescriptions in a given year, the person must pay 100 percent of the cost of their medications unless and until spending reaches $5,100. The doughnut hole, which Congress created to lower the cost of the program, has been an irritant for seniors and Democrats, who have long vowed to close the coverage gap as soon as possible.

Small businesses that have up to 25 workers and pay average wages under $50,000 are eligible for tax credits to help cover their employees. States may also draw down federal matching money this year if they begin expanding Medicaid to people who earn up to 133 percent of the federal poverty level (about $14,400 for an individual). Moreover, the government will reimburse employers up to 80 percent of the cost if they offer health insurance to retirees over 55 who don't qualify for Medicare. Regulations must spell out all of this in detail, and Health and Human Services Secretary Kathleen Sebelius has significant leeway in defining such concepts as pre-existing conditions and dependent care.

By the end of September, the act will prohibit insurers from imposing cost-sharing on patients for preventive medical services identified by the U.S. Preventive Services Task Force. In addition, insurers must cover young adults up to age 26 on their parents' policies and must not exclude children under age 19 from coverage because of pre-existing medical conditions. Insurers are forbidden to cancel anyone's policy unless the initial application was fraudulent, or to impose lifetime benefit limits.

Sebelius is encouraging insurers to voluntarily make some changes sooner, and already a handful of carriers have agreed to speed up their coverage of young adults on their parents' policies. The secretary announced last week that Blue Cross Blue Shield plans, Kaiser Permanente, and Humana will begin covering young adults before the end of September.

The law requires HHS and other agencies to take a number of other steps by the end of the year, including:

• Reduce annual increases in Medicare payments for inpatient hospital, home health, skilled nursing, hospice, and other services.

• Increase the Medicaid drug rebate for brand-name drugs.

• Create a process for the approval of generic versions of biologic drugs.

• Launch a nonprofit institute to research and compare the effectiveness of medical services.

• Establish a committee to develop a national health care workforce strategy.

• Administer a 10 percent tax on indoor tanning services.

The federal government, states, employers, insurers, and medical providers have all begun laying the groundwork for the massive changes to come in 2014 and beyond. Washington will need to work with states to establish health insurance exchanges and expand Medicaid programs. Federal administrators will also have to prepare for new taxes (and tax breaks), and for Medicare pilot projects to test such concepts as accountable care organizations and bundled payments.

Implementing Health Care Reform

Details from the New York Times.

Texas Bible Classes

Texas is in the process of figuring out how exactly to implement a law passed last legislative session that allowed school districts to offer an elective focusing on the Bible. The problem of course is doing so without violating the 1st Amendment.

People are free to exercise their religious beliefs as they choose--save for human sacrifices or other similar practices--but government cannot establish a church. This creates tension. People like the idea that they can use their public schools as venues for religious expression, but the classroom has historically been a place where governments establish, or impose, religious beliefs.
The bill was modified as it passed through the legislature in order to ensure that it focused on historical aspects of the document and steered clear of preaching. That's been the objective of the Texas Education Agency and the Attorney General's office as they determine how the bill can be converted into specific rules. Aside from the constitutional issues associated with the case, its a great case study of how laws get implemented.

Let's walk through the history, via available Houston Chronicle stories.

- The bill is introduced by Warren Chisum and considered in the House Education Committee.
- The bill passes the Texas Senate and is sent to the governor for a signature.
- The State Board of Education requests clarification about the bills language.
- The Attorney General states that the course passes Constitutional muster.
- The Chron editorializes that the standards are too loose, preaching may well result.

Here is a document from the Texas Education Agency site outlining hearings and providing links to other documents related to the establishment of a Bible based curriculum.