After Health Reform Passes ‘The Fight Just Moves To A Different Venue’ — The Case For A National Exchange

“Should someone in Idaho or Nevada have significantly different health care coverage from someone in Massachusetts,” Reed Abelson asks in today’s New York Times. “That, essentially, is one of the biggest questions Congress will be wrestling with” as it tries to reconcile the House bill’s national exchange with the Senate bill’s state-based approach.

The Senate health bill would exacerbate the regional differences in health coverage by requiring all 50 state legislatures to pass separate legislation establishing 50 new health insurance exchanges. “The same state officials who now oversee the insurance market with varying degrees of intensity” would also be responsible for regulating the new insurance marketplaces.

Meet Florida’s State Sen. Don Gaetz. Under the Senate bill, Gaetz and other state lawmakers across the country would help implement the new exchange and regulate insurers. On Monday, Gaetz pledged to “resist making other changes required to implement the reforms.” “We are not trying to figure out how to lay down with this,” Gaetz told a crowd of state legislators. “I think we are going to look for ways to roll back provisions in this bill and try to get more state choice and more flexibility and more local business control of health care options.” Gaetz predicted that in 2010, candidates opposed to the federal reform would win election, setting off a protracted fight. After the bill is signed into law, “the fight just moves to a different venue,” Gaetz said. “And by the way, I welcome the fight.”

A number of Republican gubernatorial candidates have already announced their desire to repeal reform. Attorney General Bill McCollum, who is running for governor in Florida signaled that “he would challenge the legality of any federal legislation that forces individuals to buy coverage.” Yesterday, South Carolina Attorney General Henry McMaster, also running for governor in his state, appeared in Washington to rally support for his campaign to challenge the constitutionality of reform. More than 14 states have already announced that they would put the question of repealing reform on the ballot and top Republicans have pledged to run the 2010 Congressional elections on rolling back the measure.


For reform to work, lawmakers who have pledged to “roll back provisions” of reform should not be responsible for implementing it. House and Senate negotiators must adopt the House bill’s more centralized approach or develop a compromise that establishes a national exchange but allows states a certain level of flexibility. States should be able to respond to local needs and conditions without dragging their feet on insurer oversight and regulation. After all, reform’s success or failure will be determined by the implementation process. And if the final health care bill outsources these tasks to Don Gaetz, this whole effort was for naught.