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Now Comes The Hard Part -- States Scrambling To Understand Health Care Reform Law

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"A lot of it is still sort of a moving target. We're going to learn as it happens," Ben Kieckhefer, a spokesman for the Nevada Department of Health and Human Services, told TPMDC in an interview this week.

Changes to and expansion of Medicaid -- and plans for the federal government to reimburse states for increased costs -- are among the trickiest of the new provisions. State insurance commissioners are also being given new authority to regulate insurers and scrutinize proposed rate hikes. They also are helping state providers implement new electronic medical records systems. Many of the changes don't take effect until 2014, but states told me they need to start laying the groundwork now. Officials also said they haven't been given clear direction from the administration about what they need to do to hit their targets for the changes.

Officials said many citizens who may have tuned in for bits of the contentious, ever-changing and sometimes misleading national debate on health care reform aren't sure what's in the bill. Telling them isn't so easy, either.

As the Senate was voting on reconciliation late last week, Democratic leadership started talking about implementation plans. Officials at the National Governors Association told me this morning they are still reading the health care reform law before they can help states make heads or tails of it.

What's more, the lawsuits complicate things for state health officials, who are tasked with administering Medicaid no matter what and tell us privately they aren't sure what to tell constituents who call asking what will happen. It could take years before the lawsuit is settled, and Obama administration officials say they are confident the law will withstand any challenge.

One official in a state that's suing dismissed my questions about how the state would inform citizens since the state's official vow is the law is unconstitutional. In Florida, which has joined the lawsuit, a spokeswoman told me today that it's "premature for us to comment on how health care reform will affect Florida."

Staffers caught in the middle of the politics have been attempting to craft informational guidelines for their citizens and the press without partisan leanings, not a simple feat either when Republican state officials see the lawsuit as a new conservative litmus test and everyone is looking toward the 2010 midterm elections.

In New Mexico's case, educating the public means explaining the difference between state reform already on the books and new changes coming. Children up to age 25 already are allowed to stay on their parents' insurance in New Mexico; in six months the new federal law will kick in and allow them to remain on their parents' insurance up to age 26.

New Mexico started their implementation plan by telling state employees what health care reform means to them, letting them know in a weekly internal memo that they will need to take on the additional responsibility of getting more people enrolled in Medicare.

"We are still analyzing what this means to New Mexico," a state health official told me in an interview.

Health and Human Services Secretary Kathleen Sebelius told reporters right before health care reform was signed that once it became law, "that important work to transform our health care system will begin." She said the administration will help states understand "what really is in this bill."

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