Yesterday, the House voted to eliminate federal grant money to help states establish their own insurance exchanges — market places that will help consumers purchase and compare coverage options beginning in 2014. As the Hill’s Sam Baker reports, “[t]he measure passed 238-183 after Republicans dismissed complaints that the bill would tie states’ hands and shift power to the federal government.” Rep. Michael Burgess (R-TX) maintained that “Washington would dictate operation and structures of the exchanges” to the states:
BURGESS: Will Washington or Austin choose the official benefits that will be paid to patients. Section 102 of the Patient Protection and Affordable Care Act. Section 102 says that responsibility is Washington’s. Will Washington or Austin control whether health savings accounts and other consumer driven plans can be offered? Section 4202 D2 says Washington wins that round….I think Mr. Speaker you begin to get the impression, this is not state flexibility this is of and run by Washington D.C.
But as Rep. Frank Pallone (D-NJ) pointed out, the amendment would not remove the requirement for states to set-up the new market structures by 2014 and would therefore increase federal control over the states. As the Congressional Budget Office has pointed out, “[u]nder H.R. 1213, CBO assumes that some states will move forward without federal funding to establish exchanges, but that the federal government will be required to take responsibility for setting up exchanges in more states than is expected under current law.”
“My colleague on the other side, I don’t understand. You are saying that you want Austin to do it. You want Austin to have the flexibility to frame a program that is done best because you think Austin and the state is going to do it best, well if that’s the case, why in the world are you putting this bill on the floor,” an exasperated Pallone said in response to Burgess. “By passing this bill you are simply abdicating the right of the state to make a decision and to have the flexibility to set up a good program that’s tailored to the state. It’s the exact opposite of what you’re saying you want to do.”
While the Affordable Care Act does establish a federal baseline of protections and regulations, states that choose to operate their own exchanges still have a great deal of flexibility. For instance, states can establish their own governance structure for the exchange — through a state government agency or a nonprofit entity or partner with different states — develop sub-state exchanges, join a regional exchange, decide whether or not to have separate exchanges for businesses and individuals and families, and develop a process of selecting which plans can participate in the exchange. States can also include public plan options or insurance cooperatives (co-ops) in their exchanges.