WASHINGTON — With a deadline to set up a new health-care system 10 months away, Democrats and Republicans in Washington and in state capitols around the nation are debating the merits of the overhaul legislation with the same intensity they did when the broad health-care law was enacted nearly three years ago.

On Thursday, health-care directors from five states, including Arkansas Medicaid Director Andy Allison, made their views known on Capitol Hill.

The two from states with Democratic governors, Allison and Maryland Health Secretary Joshua Sharfstein, told members of the House Energy and Commerce Committee that they saw the law as an opportunity to extend coverage to people in their states without insurance and rein in health-care costs.

The three health-insurance-agency directors from states with Republican governors, Louisiana, Pennsylvania and Wisconsin, told the members that federal regulators had been uncooperative in providing assistance as the states prepare to make the changes, and that financing the new law would crowd out other state spending priorities.

Today, states face a deadline for declaring whether they will run their own ex- changes under the system or rely on a federally run exchange. By Thursday, 14 states and the District of Columbia had announced such plans. Arkansas has plans to run a hybrid option whereby the state retains control over consumer assistance and some aspects of regulation.

The states face other decisions. The U.S. Supreme Court ruling this summer on the Patient Protection and Affordable Care Act allowed states to opt out of an expansion of Medicaid, the state-federal healthcare system that largely benefits children and the poor.

Allison told the committee that he hoped Arkansas lawmakers would vote to expand the program so it covers up to 250,000 more low-income adults.

Doing so, he said, would bring an additional $800 million of federal money into the state each year. The expansion also would increase Arkansas’ tax revenue by $713 million between now and 2025, according to a study by the Arkansas Department of Human Services. Allison said savings would be generated by the expansion because that state would no longer have to foot the total bill for certain patient populations, such as children in the state’s ARKids B program and pregnant women, and for “uncompensated” expenses currently paid by other state agencies. This includes health care for prisoners and patients at community health centers.

“Put simply, Arkansas’ economy will be hundreds of millions of dollars larger if it chooses to expand Medicaid,” Allison said. “The fiscal benefits will outweigh the cost.”

Health-insurance regulators from other states didn’t have as rosy an outlook.

Pennsylvania is having a hard time dealing with the “myriad of mandates and onerous procedural requirements” of the law, testified Gary Alexander, that state’s secretary of public welfare.

Pennsylvania has opted not to build a state exchange. And Alexander said he was disappointed that the Obama administration had not allowed the states the flexibility to only partially expand Medicaid’s offerings, which he warned would eat up state budgets if fully expanded.

“The growth of these programs keep crowding out education and transportation, and this will have a direct impact on jobs,” he said.

The partisan split was evident in comments made by members of the panel.

“The Obama administration has not provided critical information to Congress, the states, or the health plans that they need to begin implementing the health-care law’s exchanges [and] Medicaid expansion,” said Rep. Michael Burgess, a Texas Republican.

Republican Rep. Phil Gingrey of Georgia said it’s hard for governors to draft budgets when there’s so much uncertainty regarding the exchanges.

“We have states still looking for direction,” he said.

Rep. Frank Pallone, D-N.J.,, said Republicans couldn’t stop “Obamacare” at the ballot box, so they’re trying to sabotage it instead.

“I’m beginning to understand the Republican playbook,” he said. “The next move is to delay implementation because of lack of information.”

Rep. Henry Waxman of California, the committee’s ranking Democrat, accused agency heads from Republican-led states of stalling.

“For some states, no amount of information will ever be enough,” Waxman said. “And that is the tragedy of politicizing a law that will benefit so many Americans. This was one of the issues in the [presidential] campaign, and you lost. You run these programs and you ought to support them.”

Allison predicted that completing the Medicaid expansion would be challenging but said his agency is up to the job. For that to happen, however, legislation to dedicate state funding for the expansion would need to clear the Arkansas General Assembly by a three-fourths supermajority.

Allison said he hoped state legislators would take action.

“The ball is in their court,” he said.

While political partisans were debating the legislation on Capitol Hill, state lawmakers in Little Rock were raising objections in a similar vein.

In Arkansas on Thursday, state lawmakers approved an $18.6 million federal grant to continue building an insurance exchange — a crucial part of the Affordable Care Act — but not before Republicans criticized state-exchange officials, saying they had given them contradictory information about whether partnering with the federal government was the best fit for Arkansas.

Insurance Commissioner Jay Bradford and Exchange Planning Director Cynthia Crone said they also were frustrated with shifting federal deadlines and an initial lack of specifics from the federal government but hadn’t intentionally misguided legislators.

“There was never any intention from me to mislead this body here,” Bradford said.

Crone said federal regulations have evolved since 2011, but federal officials “are on task” in providing the online portals and other parts of Arkansas’ exchange.

“There is no reason to believe they won’t be on time” for the opening of the marketplace in January 2014, Crone said.

Republicans led the effort to kill the state-run option for the state in 2011, and many on Thursday questioned why Arkansas should pursue a partnership with the federal government.

Rep. John Burris, a Harrison Republican, said that he was frustrated to learn only recently that states that plan — like Arkansas — to partner with the federal government have the option to take full control of their exchange in future years. He also questioned why a 3.5 percent federal premium fee placed on all policies purchased on the exchange wasn’t announced earlier.

“The frustrating thing is the varying levels of information and the contradictory statements. Maybe that’s just ... dealing with the federal government ... but I didn’t think anything could make Medicaid expansion seem like a fun debate,” Burris said.

In Washington, Gary Cohen, deputy administrator of the federal Centers for Medicare and Medicaid Services, defended his agency’s outreach efforts.

“I’m confident the states and the federal government will be ready in 10 months,” he told lawmakers on Capitol Hill. “I know states are ready because they have the information and the resources they need.”

Cohen said the agency had held 48 teleconferences with 5,400 participants from the states, and two conferences with more than 1,000 state attendees to discuss implementation of the exchanges.

Arkansas’ exchange is envisioned to be a regulated, competitive marketplace where consumers can purchase health coverage, with federal subsidies available to most families with incomes up to 400 percent of the poverty line. Planners expect about 211,000 people — most of them previously uninsured — to sign up when the enrollment begins Oct. 1, 2013.

Under the partnership model, the state will handle consumer assistance and outreach, certify plans and handle complaints. Most importantly, Bradford said, insurance companies will be more responsive to state concerns.

“They’ll have to return our calls,” Bradford said.

Three insurance companies — Arkansas Blue Cross and Blue Shield, QualChoice of Arkansas and United Healthcare — have almost all of the state’s insurance business now and would likely be responsive to the state Insurance Department anyway, said Sen. Johnny Key, R-Mountain Home.

State Sen. Jeremy Hutchinson, a Little Rock Republican, questioned the need for a 6 percent premium fee, which includes the recently announced federal fee. The 6 percent fee will generate about $25 million for state coffers. The federal government will reimburse the state for its estimated $15 million to $18 million of costs in running the exchange from the money collected from its 3.5 percent fee; the rest of the federal fee stays with the federal government.

An existing 2.5 percent state premium fee raised $138,817,025.91 in fiscal 2011, according to the Insurance Department. That money went to general revenue. The $25 million in new money created by the purchase of exchange policies also is likely headed to general revenue. Gov. Mike Beebe hasn’t made up his mind about how to recommend spending the money, his spokesman Matt DeCample said earlier this week.

Bradford told Hutchinson that the federal fee couldn’t be reduced but the Legislature could reduce the state’s fee.

State Sen. Cecile Bledsoe, a Rogers Republican, said Arkansas should move slowly.

“Anytime we rush, it seems like we create a problem,” she said.

But Crone, the state exchange planning director, said planners haven’t rushed anything.

“I feel like we’ve been begging to move forward for two years,” she said.

Rep. James McLean, DBatesville, said his discussions with business leaders convinced him that there is “near unanimity” in the business community “that this is the way to go.”

What has been treated as a political issue, he said, is now a business issue and should be treated as such.

Front Section, Pages 1 on 12/14/2012