Five states offered different views of the Obama administration's flexibility in implementing Affordable Care Act health insurance exchanges and expanding Medicaid at a House Energy and Commerce Health Subcommittee hearing Dec. 13.

Pennsylvania, Wisconsin, and Louisiana health officials testified that ACA puts the federal government in the position of dictating policies to states, and they said the health care reform law is likely to be too costly for states to implement.  Maryland Department of Health & Mental Hygiene Secretary Joshua Sharfstein, on the other hand, said his state has received good cooperation and flexibility in helping the state establish its own state-based exchange. And Andrew Allison, director of Arkansas' Division of Medical Services, said Arkansas stands to reap $800 million a year in Medicaid benefits if the state legislature goes along with Democratic Gov. Mike Beebe in electing that option.

In a separate action, 10 Republican senators led by Finance Committee ranking member Orrin Hatch (R-Utah) sent a letter Dec. 13 to Treasury Secretary Timothy Geithner, Health and Human Services Secretary Kathleen Sebelius, and Labor Secretary Hilda Solis calling for an extension of the 30-day comment period allowed for three proposed rules issued Nov. 20 involving the health insurance exchanges: "Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation;" and "Health Insurance Market Rules; Rate Review;" and "Incentives for Nondiscriminatory Wellness Programs in Group Health Plans."