Politico’s Sarah Kliff has the best rundown of where states stand as they move to implement the most important element of the Affordable Care Act: the state based exchanges that will serve as regulated market places for insurance beginning in 2014. Under the law, if states fail to establish their own exchange, the federal government will build one for them — something a surprisingly high number of conservative states are willing to accept. From Kliff’s piece:
- LOUISIANA: When asked whether [Gov Bobby] Jindal would support or sign off on legislation authorizing a health exchange, press secretary Kyle Plotkin said, “No. Obamacare is a terrible policy that needs to be repealed and replaced. It creates enormous new costs and future unfunded liabilities for states financing their Medicaid programs.”
- FLORIDA: Republican Gov. Rick Scott has been unequivocally clear in his opposition to the health reform law and its implementation. “We’re not doing anything with regards to the exchange, I don’t believe in the exchange” he told POLITICO in an interview at the National Governors Association meeting last month.
- MONTANA: The Republican-run state Legislature has come out aggressively against the health reform law, pushing forward on legislation not only to block a health exchange but also to compel its attorney general to join a lawsuit challenging the overhaul. Legislation to authorize a health exchange has meanwhile languished in committee.
- GEORGIA: The Georgia Tea Party Patriots showed serious muscle last week when they squashed a bill, approved by the Legislature and sitting on Republican Gov. Nathan Deal’s desk, that would have authorized a health exchange commission. With the legislative session wrapping up in mid-April, it’s unlikely that any other exchange legislation will move this year.
- ALASKA: Gov. Sean Parnell (R) has waded gingerly into the issue of health exchanges, announcing last week that he would take action to study the issue of health exchanges but not pursue the $1 million planning grant.
For one thing, this is counter-intuitive. Republicans are relying on the federal government to expand coverage to state residents, helping bring about the very thing they fear — greater government involvement in the health care sector — while most Democrats (many of whom are moving forward with exchange construction and design) are actually employing state-based solutions.
The GOP will argue that the exchange requirements are confining and burdensome — you may even hear that they’re a top-down-solution to a state problem. But in reality, states will have a good deal of flexibility in designing and forming the exchanges. They will be able to run their own insurance marketplaces (or partner if with other states), determine which insurance companies can offer coverage and establish benefit rules in their exchanges. But surprisingly, Republican governors are giving up that flexibility in favor of a federal intervention.