Twenty-one Republican governors sent a letter to the Secretary of Health and Human Services asking for more state control over certain provisions of the Affordable Care Act, including defining essential health benefits and setting minimum standards for insurance exchanges. The governors threatened not to set up state-based exchanges if their requests are not addressed. The Secretary responded with a letter outlining options states have to reduce Medicaid costs and indicated further discussion is needed.

1. States with Republican governors kept up the pressure last week
on Washington to give the states greater control over health care
under the Patient Protection and Affordable Care Act (PPACA).
Twenty-one Republican governors sent a letter to Health and
Human Services (HHS) Secretary Kathleen Sebelius asking for
greater authority over some provisions of health reform, including
the ability to define "essential" health benefits and set minimum
criteria for participating in insurance exchanges. They threatened
not to run their own state-based exchanges if HHS does not act on
their requests. Sebelius quickly responded with her own letter in
which she reviewed the various options states have to reduce costs
in their Medicaid programs, and she indicated.
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