Civil War Over Health Exchanges

States Give Obamacare A Vote of No Confidence

Investors Business Daily editorial, December 18, 2012

December 18, 2012 -  President Obama’s Health Law that the 50 states must set up health exchanges is getting a lot of bad press.  

Critics are saying the law is an administrative nightmare,   will cost States more than they can afford, does not give States sufficient information to do the job,  demonstrates federal bureaucratic planning incompetence,  deprives States  of opportunities to design lower cost, more flexible Medicaid programs,  gives the federal government  absolute control  over state affairs, and  will cause cost overruns on already stressed state budgets.

Here are a few of the critical comments.

--Investors Business Daily , December 18– “Under ObamaCare, states were supposed to agree to set up so-called insurance exchanges — which would act as a clearinghouse for government-approved health plans and distribute the insurance subsidies included in the law.
 

But just 18 states have agreed to build them. The rest — which include eight run by Democratic governors — are leaving it to the federal government to do the dirty work of setting up these massively complicated exchanges. That's a remarkable vote of no confidence on a central element of ObamaCare, and one that's caught the White House completely by surprise.

Which means the Obama administration now has to figure out how to run exchanges in 32 states — a task it is hardly prepared to take on, if it's capable of ever handling it at all.

Why should states play along? Setting up an exchange only means that states will have to spend the money to run them — which will cost tens of millions of dollars they don't have — and then suffer the blame when things inevitably go horribly wrong.”

--Wall Street Journal, December 18,  “Obamacare Faux Federalism”.  ‘Having failed to persuade 26 states that participating in ObamaCare is a good deal, the liberals behind the law are denouncing these dissident Governors as federalist hypocrites. A few critics on the right are chiming in and arguing that the 26 are inviting worse results once the feds swoop in.

So someone ought to say a word on behalf of the people who run state governments in the real world and have examined the health insurance "exchange" question in detail. They've seen enough to know that the choice to set up and run these insurance bureaucracies is not a choice at all.

The "federalism" ruse is a special instance of bad faith. If federal-state cooperation means anything, then it requires some element of genuine state control and the freedom to innovate. The Health and Human Services Department is abusing the laboratories-of-democracy line as cover even as it prohibits states from doing experiments. And it's dictating details down to the lab coats and microscopes.

The folks at HHS envision the exchanges as centralized, interventionist, hyper-regulatory bodies. HHS's idea of flexibility is telling the states they can make the exchanges even more centralized and interventionist. But if they don't agree to that model, then Washington will impose it anyway.

 

--Repairing the Healthcare System,  a well-regarded blog of Stanley Feld, MD, December 18, “Problem with State Health Insurance Exchanges”

Over 60% of the population is opposed to Obamacare.

States refusing to set up halth insurance exchanges are reflecitng public opinion.

Theorectically,  health exchanges are a good idear Pratically, they re not

 

December 5, 2012 , “States Decline to Set Up Exchanges.”

HHS was supposed to certify HIX blueprints for all 50 states by Jan. 1, 2013. The states are supposed to be ready for open enrollment by Oct. 1, 2013 and operational on Jan. 1, 2014.

As of November 19, 2012, seventeen states, NY, MA, RI, NH, DC, KY, DE, W VA, MS. NM, CO, CA. OR, NV, MN, WA, and HI have declared their intention to establish a State-based Exchange (SBE).

Federal regulations have not been released. I will bet some of above states will drop out when they will be able to calculate their costs.

The nineteen states that have definitely declined to participate in the health insurance exchanges at this point are TX, OK, KS, NB, ME, VT, SD, ND, AK WY, MT, VA, GA, AL, MO, SC, OH, IN, WI.

Most of these states realize the financial burden, administrative burden, and challenge to states rights Obamacare’s health Insurance exchanges will place on their states as they try desperately to balance their own budgets.

An additional five states, AR, NC, Il, MN, and ME are pursuing an ill defined partnership plan offered by the Obama administration to set up a health insurance exchange.

Nine states are undecided but leading toward rejection.

A total of 28 states are leaning towaed total rejection of the health insurance exchange concept and 22 states are interested.

Tweet: At this writing,  32 states have declined to set up  health insurance exchanges, leaving the task  to the government which it is ill-prepared to perform.