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State workers feeling pain of implementing health-care law

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By Darryl Fears and Lena H. Sun
Wednesday, September 22, 2010

Even as President Obama prepares to acknowledge the six-month mark since he signed his health-care overhaul into law, the legislation remains something of a mystery for patients and politicians alike. Its impact is instead being felt largely by state workers nationwide whose job is to implement the law - and thus begin the mammoth task of transforming the care Americans receive.

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For legions of men and women such as James Focht, who coordinates health information technology for the District, that means longer hours and extra work.

When Focht's alarm clock screeched at 3:45 one recent morning, he pulled himself out of bed in the dark, switched on a computer and started tapping out a proposal for a federal grant that would make it easier for hospitals, doctors and other providers to share electronic patient records. He hurried to finish his draft, take a shower and get to work at the D.C. Department of Health Care Finance by 8:15 a.m. so that other executives could edit the proposal and send to the Department of Health and Human Services by 5 p.m.

Then he began working on the next grant.

Focht and other bureaucrats in his D.C. office are quick to say that the health-care overhaul was worth the extra effort. But the task of expanding Medicaid to include millions more Americans, converting paper medical records to electronic records, and creating an entirely new health insurance marketplace is falling on state health agencies during a recession that has cut their budgets. And staffs - trimmed by layoffs, early retirements, furloughs and hiring freezes - are feeling the strain.

The federal government, meanwhile, is rushing to implement the law's major provisions by 2014. HHS has rolled out grant offerings worth more than $12 billion to help states with overhaul-related initiatives, such as establishing home-visitation programs to improve the well-being of children, increasing the number of primary-care professionals and planning to establish consumer insurance exchanges, a centerpiece of reform.

On Thursday, some of the law's earliest provisions will take effect, including allowing many children up to the age of 26 to remain on their parents' health insurance plans and forbidding plans to drop clients who become sick.

But applying for the grants isn't easy, and experts are starting to wonder if states with depleted budgets - such as California, Oklahoma and Virginia - can keep up with the conveyer belt of grant opportunities and account for millions of dollars once the money is awarded.

"Obviously, we have concerns that the federal government not just pass out money without knowing how it's going to be spent," said Diane Rowland, executive vice president of the Kaiser Family Foundation. "But it's a tricky balance of doing that and not overburdening agencies."

Alan Weil, executive director of the National Academy for State Health Policy, said implementing the overhaul is "a phenomenal task." Federal grants are the mother's milk of reform, he said, but added that he's not sure if there are enough workers to apply for them.

"Someone has to sit down and figure out things, write a strong proposal. What will we use the money for? What's our timeline? And this is all on top of what you normally do," Weil said. State health finance agencies, including the District's, usually manage Medicaid and Medicare services. The District and some states also manage public contracts to health-care providers that offer insurance to low-income residents who do not qualify for federal coverage.

HHS, the federal agency in charge of implementing reform, is not worried about whether states can handle the fast pace of the overhaul, said Paul Dioguardi, director of intergovernmental affairs.


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