Tommy Thompson: GOP Governors Should Implement Health Care Exchanges

Former Wisconsin Gov. and Health and Human Services Secretary Tommy Thompson (R) has long been out of step with today’s conservative Republican orthodoxy. He’s supported the individual mandate, argued against repealing the Affordable Care Act and even opposed portions of the Paul Ryan budget. Now, this potential GOP Senate candidate is going a step further, calling on Republican governors to implement the health care exchanges that are part of the Affordable Care Act:

I am writing to suggest that governors of both political parties have tremendous opportunity to use free market principles and set up health insurance exchanges which work and give constituents freedom of choice. There is a lot of discussion about health insurance exchanges as it relates to President Obama’s Affordable Care Act. Some governors have a negative opinion of insurance exchanges and I believe that by doing so they are giving up a tremendous opportunity to use marketplace choice and allow insurance companies to compete in their respective states. It would be a terrible mistake to have governors give up that opportunity to set up exchanges and forfeit that opportunity back to the federal government which would limit states’ rights and their constituents’ ability to pick and choose the best insurance for themselves and their families.

Now to be clear, Thompson isn’t proposing that Republicans adopt the kind of robust insurance exchanges that Massachusetts and California are pursing — exchanges that act as a prudent purchasers and negotiate price and coverage on behalf of their beneficiaries. He’s calling for something far milder. It’s a model that many Republicans have supported in the past, one that’s rooted in Utah’s flea market-like exchange where any insurance company can offer a plan and consumers could potentially be suckered into some fairly inefficient and costly coverage. That’s a far less effective approach — the Massachusetts Connector has connected about 217,000 people to coverage while Utah’s exchange reached 3,583 enrollees — but at least it’s some kind of start towards implement the health care law rather than resisting it.

And Thompson offers one final warning: “If states do not build an exchange, the Affordable Care Act requires that the Federal government step in and run the exchange…If you give control of the exchange to the Federal government, you also give them control of the Federal Medicaid grant program. Do we really need to provide the Federal government day-to-day control into the largest liability items on the state budget?” That’s a question some Republican governors already know the answer to.