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Map showing party affiliation by Governors, current
Now that we have approached what should have been the deadline for states to say whether or not they plan to build state exchanges to comply with the Affordable Care Act, it is clear most of the Republican controlled states will not. The administration’s last minute decision to push back the deadline by another month to try to encourage more states to create exchanges seems unlikely to succeed.
Frankly, I consider this a positive development. I’ve always thought the idea of the ACA being based on state run exchanges instead of one run by the federal government was extremely stupid.
If states want to go beyond what a federal exchange would do, like California’s exchange which will be an active purchaser or D.C.’s which will combine all the small markets, only then does it make sense for a state to make the investment in building their own system. On the other hand, there really is no point in a state taking all the effort to build an exchange that only meets the minimum federal standard and will be basically identical to having a federally run exchange.
Financially this should be far more efficient. Creating one of these exchanges is an incredibly expensive IT investment but adding more people to an existing system should be a rather small cost. It should be much cheaper for the federal government to just build one system and use it in 30 states, rather than make 30 states waste money building 30 different systems.
On a practical level having governors opposed to Obamacare not involved in running the exchanges should produce better outcomes. I would much rather the exchange I’m using be run by the Obama administration, which is heavily invested in trying to make the law work, than have it run by Republican governors, who are ambivalent about the law’s success.
Politically it is seems as close to a win-win as you can get in the situation. Republican officials who think the law won’t work get to wash their hands of it, Democrats get to try to prove it can work, and regular people will still have access to an exchange.
Attempts by some liberals to try to shame Republican governors into creating state-based exchanges are misguided. Republican controlled states deciding to have the federal government run their exchanges seems like the least bad of the possible outcomes.
Map from Wikipedia under Creative Commons license.
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And plus also doesn’t this bring us along the path to single payer? I hope my terrible Republican Governor Susana Martinez says, “No”. She’s terrible, in case I didn’t mention it.
I think republicans don’t like the health law because they know millions of Americans who are eligible for Medicaid have no idea they are eligible for Medicaid. But once the law is you must have insurance they are going to find out they are.
I’m surprised the Republicans have not thought of this to undermine the ACA. They are pretty adept at burrowing into government agencies to eat out the foundation much like termites.
We have a terrible Senator also. Amy Klobuchar. We had to gather petitions and take them to her office to get her to vote for the ACA. Move on was all over us to try to get her to budge. Now we can sit back and watch her sign on to cut our Social Security.
I would be interested in the list of “liberals” who attempted to shame. It must be rather short.
Sounds like a good idea. Should we all mail our governors to tell them it is a terrible idea to make your own exchange. You know like more money we don’t have. Let the Feds do it.
Wow if only there were some kind of system all Americans were already a part of and already in place. seems like that would save tons of time and $$$ on setting on the systems and making sure everyone had equal access no matter where you lived.
agreed that one Federal exchange would be preferable.
As a healthcare practitioner, I can assure you all that regardless of how it’s set up, these exchanges do nothing to alleviate our issues with having to deal with multiple payors’ idiosyncracies around billing and claims payment. That nightmare continues. I have supported a single payer system for nearly 40 years! Obama doesn’t give a shit about practitioner concerns.
What strikes me the most about this post as soon as I saw it all I could hear in my brain was Hopey Changey Obama yelling “There are no Blue States, there are no Red States…” Yeah, right.
Fact- the exchanges will not lower costs or increase access.
find a single hc expert on either side that thinks so.
Excellent point. It seems to me the government has no trouble spying on you, and can pick out a potential “terrorist” from a few keystrokes. But providing healthcare ? They hardly know that you exist.
If the design of the new exchanges are as bad as the current design for the Medicare Part D online application, it’s going to be basically worthless. It’s the worst hunk of junk out there, you can’t really compare insurance companies and are essentially forced to throw a dart at the screen to pick one. Not to mention that healthcare insurance is 1000 times more complicated than Rx insurance alone. And having each state set up their own exchange – what an incredible WASTE of IT resources, it’s a criminally inefficient and wasteful way to do things.
ACA – making a bad idea (that healthcare should be for-profit) even worse.
A+, Jon, in finding the silver lining.
I’m confused…..this was one of Obama &the democrats’ “accomplishments???
Well I suppose it’s like milk chocolate…….did you know there were bug parts in most chocolate????
Obama doesn’t give a shit about patients, premium-payers, or taxpayers either. Unlike Big Insurance, Big Pharma, Big Hospital, and Big Device, we weren’t important enough “stakeholders” to be worth meeting with in secret in order to negotiate PPACA behind closed doors.
Most of the right were against the Govt. takeover of healthcare, so the States were given an option.
The ones complaining of doing the State exchanges are those who now want the Feds to do it. Baffling for sure! Are they to lazy or do they believe politically this will help prove it as not working?
I believe if this happens positively, the next easy step is “THE PUBLIC OPTION” or “MEDICARE FOR ALL”! Really make the private sector work for a living to help patients and preventative care rather then line their pockets &shareholders!!!!!
Since the ACA the average insurance increase in the private sector has only gone up by 4 1/2% in the state of WI. That is a lot better then the typical rise of 28% over the last few years……!
Jon,
My guess is that part of the deal Obama cut with insurers is the preservation of state based monopoly pricing. A Federal exchange is perilously close to a public option, from the perspective, say, of a ND insurer.
I’m just going to quote shamelessly from something Don McCann of Physicians for a National Health Program wrote yesterday in response to a press release that made more or less the same point as you:
—- Why employers’ health benefit cost growth of 4.1% is a fraud, Physicians for a National Health Program, 15 November 2012
As I understand it, the Federal govt rules under which States would have to operate their State exchanges make it essentially a Hobson’s choice.
Very good point. In the UK, France, Germany, etc. doctors are paid via EFT in less than 4-days. What was interesting is that the have no staff that had to deal with myriad insurance companies, having to call insurance companies for coverage approval, etc.. The NHS does all that so practitioners only have to deal with patients. A practitioners staff is made up, not with office administrators, but actual medical people who extend the practice’s patient coverage (calling elderly about flue shots, follow-ups, house visits, preventive care, pre-natal, etc.) Hope it happens here.