The temperature hit 100 degrees in the nation’s capital and the Patient Protection and Affordable Care Act (PPACA) turned 100 days old during this July 4th holiday week. Even though Congress is on recess this week, there is a still lot of health care in the news.

July 1 marks the beginning of fiscal year 2011 for most states. Some states had expected Congress to provide another six months of aid in the form of extending an enhanced match rate for Medicaid before it left for the holiday. Some had even built the extra money into their budget, which means they have to re-do their budgets. For 2011, it appears states will have to offset the 10 percent decrease in federal funds by increasing their own spending by 25 percent. The outlook for whether Congress will provide the extension is hazy.

More than a year ago, the state Medicaid directors warned, “… the increased Federal payments alone are not enough to solve the states’ fiscal problems. States must be able to retain the flexibility to manage their Medicaid and other safety net programs to protect and maintain fiscal solvency.” States are stuck with a Maintenance-of-Effort (MOE) requirement that actually prevents them from adopting practices that could reduce their eligibility error rates. States have been prevented from adopting cost-sharing strategies that could encourage the use of generic drugs. More money has been tried. It is time to try giving states the tools they need to modernize the management of the program. If the federal government is going to experiment with payment reform, why not let the states?

How is this for crazy? The White House announced the recess appointment of Dr. Donald Berwick as Administrator of the Centers for Medicare and Medicaid Services (CMS). He will be the ninth individual in nine years to head CMS. Heading CMS is widely viewed as one of the toughest jobs in town. Counting the state share of Medicaid and the State Children’s Health Insurance Program (SCHIP), almost $1 trillion will flow through CMS in 2010. Just taking care of the day-to-day responsibilities is challenging enough. Adding the implementation of major portions of PPACA on top will be a heavy load to bear.

This is no time in health care to be lazy with so much going on. In the past few days, the Administration launched yet another website in latest in a series of catchy websites to continue to sell the American public on the new health law. Kaiser Health News reports the website, HealthCare.gov cost $3.5 million to build. But it is a bit of a fizzle as it merely directs us to places that have already been available such as Medicare’s hospital compare, or provides links to information we already have (such as the law itself) or implicitly concedes vital information is still not available. Information about high risk pools (now called the Pre-existing Condition Insurance Plan (PCIP)) is a bit of a dud when compared to say, Texas’ website on its high risk pool.

To apply for the PCIP, the federal website provides a 5-page form to download, fill out, and send to a Department of Agriculture office (no, I am not kidding) in Louisiana. There is little information about how much a person’s premiums will actually be, the specific benefits, or even who is running the health plan. Section 2715 of the Patient Protection and Affordable Care Act (PPACA) requires health plans, beginning next March, to provide an explanation of coverage documents and standardized definitions to consumers “… in a uniform format that does not exceed 4 pages in length and does not include print smaller than 12-point font.” HHS fails this standard, ending its quest in the three-legged race.

The career public servants are doing extraordinary work to try to move mountains. The problems surrounding websites, high risk pools, etc. reveal the flaws in the law and the unrealistic timeframes set by Congress.

It also appears that HHS is setting up these new PCIP health plans without regard to all of the state responsibilities to regulate health plans and provide consumer protections. The ‘supremacy clause’ seems to be part of every sentence coming out of Washington. This is self-defeating in the long run as the federal government needs the states far more than it appears to understand if the new law is actually going to work. Forcing states to act against the best interests of its citizens, such as asking them to run high risk pools without adequate funding or expanding Medicaid without the tools to run the program, simply cannot work.

There may be more fireworks ahead as the federal government continues to run roughshod over state sovereignty. As those conflicts are set in motion, the words sung by the incomparable Nat King Cole may come to mind, “You’ll wish that summer could always be here.”