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Wisconsin Gov. Scott Walker (R) announced today he won't create a state-based health care exchange.
In the timeline for implementation of the Affordable Care Act, today is a fairly important day.
After two years of political battles and a Supreme Court case, many if not most states are expected to tell the federal government Friday if they're willing carry out a key part of President Barack Obama's health care overhaul.
At issue is the creation of new health insurance markets, where millions of middle-class households and small businesses will shop for private coverage. The so-called exchanges will open for business Jan. 1, 2014, and most of their customers will be eligible for government subsidies to help pay premiums. The exchanges will also steer low-income people into expanded Medicaid programs, if states choose to broaden their safety net coverage.
In some cases, governors decided to gamble that President Obama would lose his re-election bid, and when he didn't, they sought an extension on the deadline. The White House has been happy to accommodate, handing out extensions on today's deadline to any state that asks for one.
But for several governors, they've already decided not to act -- they're aware of the deadline, but have decided not to create an exchange of their own.
Of course, the policymakers who created the law suspected this might happen, so states that refuse to create exchanges of their own will instead find Washington doing it for them. The irony is rather remarkable, since some of the same folks who decried more federal control over health care are choosing more federal control over health care.
Among them are Govs. Scott Walker (R) of Wisconsin and Rick Perry (R) of Texas, both of whom were told by national far-right groups that Republican governors who went along with the implementation of Obama's health care law would struggle in future presidential primaries.
Looking ahead, there a couple of angles to keep in mind.
The first, as we discussed in July, is how pointless the far-right opposition to this policy really is. Exchanges, like the individual mandate, used to be a Republican idea. As recently as 2008 -- hardly ancient history -- Marco Rubio, Mitt Romney, and many throughout the Republican Party thought exchanges made a lot of sense, since they give consumers choices, spur competition, create a new private marketplace, etc.
Now, the fact that Obama likes the idea leads Republicans to oppose it.
The second is a practical concern: setting up exchanges isn't easy, and the more governors decide not to bother, leaving it to DC to do all the word, the harder the task becomes. Sarah Kliff had a good piece on this the other day.
"These are systems that typically take two or three years to build," says Kevin Walsh, managing director of insurance exchange services at Xerox. "The last time I looked at the calendar, that's not what we're working with." [...]
A health exchange's first task is ensuring that those who are eligible for benefits know about them — right now, research suggests three-quarters have no idea.
That suggests a huge outreach challenge — and one the federal government may not be ideally suited to completing.
So, when governors balk at doing the work, they're inviting more federal control over health care, but they're also making matters deliberately more difficult for consumers and small businesses in their states.
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To be honest, if I lived in a state with a Republican Governor, I wouldn't want that feckin' idjit having anything to do with my health care.
I'm sure though, that Scott of FL, wants the Fed's to set it up so he can find ways to rip the new health care system off.
AGAIN!!!
I wholeheartedly agree! Republicans are just a little too trans-vaginal for my tastes in the public healthcare policy arena.
"pointless right-wing opposition" - isn't that what all of their b.s. is??
Haley Barbour said they need a "proctology exam" of their policies - but before they can, they'll have to have their heads surgically removed from that location.
Republicans do seem to have an untoward interest in the "nether regions", don't they? Trans-vaginal, proctology?
I agree TC - Republicans are badly in need of a cranial rectotomy!!
"Republicans do seem to have an untoward interest in the "nether regions", don't they?"
Yes, that's why they always put their feet in their mouth's.
Cognitive dissonance among many a person may lead to an epidemic of stupid! -Kevo
"they're also making matters deliberately more difficult for consumers and small businesses in their states."
Which is likely to cause untreated health problems and even deaths.
And will just be another reason to vote them out.
A health exchange's first task is ensuring that those who are eligible for benefits know about them — right now, research suggests three-quarters have no idea.
That suggests a huge outreach challenge — and one the federal government may not be ideally suited to completing.
I hear ACORN is not busy right now, maybe they could take care of it.
And another wingnut moron does his own colonoscopy!
Usual B.S. from TC the boil on the butt of society. Go pee on the fire hydrants somewhere else TC
Actually, I really like that idea. Not only would ACORN get the job done but it would drive the Republicans nuts.
yoo hoo - inspector??? there is no more ACORN!!!!!
(got yr back, tc)
Oh, I'm sorry . What are they calling themselves this week?
This also allows GOP governors to snipe safely from the sidelines over the inevitable glitches that will come from the initial launch of the exchanges. Same old story. But I'm hoping that what these governors can't foresee now is that in four years people will not look too kindly on them for having sat on their hands in order to curry favor with Republican extremists (but I repeat myself.)
Well, one can only hope that the voters are paying attention to the obstruction that these governors are causing and will remember come next election! Of course in Scott Walkers case, that list is long and will continue to grow.....
On a long-term basis, problems for consumers and small businesses may be exactly what Republican governors hope will happen. Then they - or their successors in the party - will be able to once again claim that the federal government can't walk and tie its shoes at the same time. No doubt they hope to reap electoral profit from this charge. Yes, this is a cynical view of the situation, but there's a good deal of evidence out there to persuade me that my cynicism is warranted.
I view this as a good thing for the folks in those states.
Would you want to be part of an exchange set up by Walker? Or Perry? Or Scott?
At least the Feds can get it right.
This is what I find amazing, these folks are just putting hands over ears and saying "la la la la la la". Refusing to do jobs, citing big government, then when federal government needed for state, they are suddenly saying, "hey thanks, buddy".
No, they are not very good at the job. They thought they would just repeal it and cut Medicare, Medicaid and leave the ER health care in place.
I can almost see their dot connecting. Repeal ACA, let everyone's premiums climb, pump up Medicare billing until it has to go away, increase profit/stocks, go invade more countries, drain federal budget so SS has to go away… voila… FDR legacy is dead.
FRD welcomed their hatred, so we should understand their hatred continues. We are not a third world nation where we just let people keep struggling every day until they die.
http://www.youtube.com/watch?v=D9yoZHs6PsU
Unless the Feds get it right.
Obamacare is an UNFUNDED MANDATE. The States are trying to trim budgets. How many more state workers will need to be hired to set up and operate these Exchanges. As usual Steve leaves out the important parts of the story.
And how would that have worked for the states if we had elected Romney? He wanted the states to do it ALL themselves, however they choose. I suspect no state would have done a thing, claiming they couldn't afford to, and we'd be back to the good ol' days of 12% annual premium increases for less coverage. More profits for the insurance companies, and millions more without insurance at all. Yeah's Mitt's plan would have been great.
You sir are a TROLL!
Scooter TURNED down more that $30 million to set up the exchanges in Wisconsin. If he had accepted that cash and made a state run exchange it would have cost this state 0.
And of course there was no way for him to have a state exchange now because where would he have found the money.
That some stunning misinformation you've posted @inspector (and in ALL CAPS at that). The Patient Protection and Affordable Care Act is fully paid for and significantly reduces the deficit (according to the Congressional Budget Office.) Also, the federal government has grants available to help states implement the exchanges. Check out how New York has used the grants to improve access to healthcare for NY'ers:
http://www.healthcare.gov/law/resources/ny.html
Excuse me June, "fully funded" by who?( I'll give you a little hint, it won't be the 47% of people that don't pay taxes) And no one HERE has explained the real cost of the exchanges.
WI DunOwner You are a fool. It would cost Wisconsin a heck of alot more than 30 milion to start and run the exchange.
Here is why Gov. Kasich turned it down in Ohio. http://www.governor.ohio.gov/Exchange.aspx
what else is new? the republicans have been in a permanent hissy-fit since 2008.
If they do it themselves they can't whine about it. Since whining about the federal gov't is one of their signature functions, they'll keep their distance.
Doing the peoples business since... well... never.
One of the most overused phrases during the 2012 campaign season was "doubling down on stupid." When it came to references to the Romney campaign, it was used a lot, as he did it a lot.
This is slightly different. This is doubling down on cruelty.
The more the states make the federal government handle the exchanges, the harder it is for the government to handle. Which increases the possibility of things going wrong. Which will give the GOP the opportunity to say "See? Government CAN'T do anything! Continue to elect us, so we can continue to prove it!"
Having survived challenges in lower courts, and then the Supreme Court, the only court left for Obamacare is the court of public opinion. it's the only chance the GOP currently has to get their brass back.
That is the strategy in a nut shell. Once again the GOP is hoping for failure.
So, let me get this right: States do NOT want the gummint interfering with their 10th Amendment rights- except when it might A) cost money B) force them to do some actual work C) provide services for their citizens.
Repubs are at their hypocritical worst when it comes to healthcare. They drone on endlessly like keeping the government out of healthcare, but then they refuse to take actions to set up exchanges that they would run, preferring to let the federal government do so. In other words, make the taxpayers in every OTHER state pay for their BAD decision. Employers prefer to cut worker hours and force taxpayers to pay for insurance for THEIR workers, yet they moan about how much they have to pay in taxes. WE end up footing the bill for THEIR greed. Then they have the audacity to claim they will hike prices or add surcharges to pay for taxes they they WON'T be paying because they cut worker hours to avoid the law. I hope every one of those workers finds a job that offers healthcare, and leave these lying whiners to go bankrupt. We live in a society, which means we all work together for the benefit of everyone, no matter their station in life, no matter their skin color, religion, gender, sexual preference, religion or politics. When one or more groups decide that they don't want to be part of that social contract, then they should not receive any of the benefits of that contract. If you want to be a selfish, greedy turd, then fine. Just don't expect me to pay to support your selfish, greedy ways.
The governor gets to say they are fighting Washington, and then they get to say "look, big government is forcing this on us."
It's politics, but it'll work with the base - which is what they want.
Perry's obsession right now is drug screening for any welfare, unemployment, and food stamp cards. In Texas the money for SNAP, once known as food stamps, is deposited on a white debit card named The Lone Star Card. A bill was filed on the first day of filing for new bills for the next session of the legislature which begins in January. for more on this just "Google, Red Dirt & Sand, which is my blog.
Living in Missouri I hope that the Federal Government does set up the exchanges. The "let them die" mindset of the republicans in this state terrifies me.
It's the same here in Kansas. These two states are doomed.
Maybe this will make it easier to slide into single-payer down the road.
I don't understand this: "makes matters deliberately more difficult for consumers and small businesses in their states." There is nothing in this post that supports that assertion! Would not larger groups reduce the cost of the insurance coverage? Doesn't economy of scale apply in this situation? Wouldn't people's rights be protected by covering them with National groups rather than expose them to the states where anything goes? What is to prevent republican states from messing with the poor and less fortunate?
That's one way to run a self-fulfilling prophecy.
Well...why the GOP is searching for a 'message' why not use their OLD message...before they decided it would give Obama a 'win' and so they had to obstruct it?
HHS has a year to set up a system, so I'd suggest going big - design the system to cover every state in which the governor has refused to set up a state exchange.
The next step would be two-fold and done simultaneously; gathering together HCI companies to provide policies and cost estimates for those policies, while also getting the word out to those who could take advantage of the exchanges. Contacting people could be done by letter and advertising. The letter would explain that, if one already has HCI and wants to keep it you can ignore the letter. If, however, you don't have HCI and want information about what the exchange will offer, simply return the enclosed card, filled out via the sase and you would be entered into the database and receive information about the HCI exchange as it becomes available. The letter would also apply to small businesses.
Undoubtedly people, individuals and small businesses, might be missed, but the major point is to contact as many eligible people as possible, as quickly as possible. Any advertising would be to help catch those missed by letters.
It's a beginning...
The residents in any state that decides not to opt out of the Federal Pool would have a better rate and coverage the more people covered by the Pool. The Feds would negotiate with a number of providers the costs for services and drugs covered by the various plans to be offered. I suspect it would be the same concept as for Senators and Representatives and Federal employees, but in this case, I would venture to predict the Pool would be larger and the costs correspondingly lower from having a better bargaining position.
And if my understanding is correct, it's a shame that Congress won't allow Medicare to negotiate drug costs as enjoyed by their drug plans. It would actually make more sense to lump these three into one massive pool, the Feds, the Medicare/Medicaid and Pool folks under one system for the purpose of negotiating services, service costs, drugs and drug costs, as applicable to the program. And by making the payments under a one payer system, even more $ savings could be realized by and passed on to the participants; the economy of scale.
Eric, we live in a democratic republic not a socialist dictatorship. You can find one and move there if you would like but, there aren't too many out there that don't tax you into bankruptcy. "FOREWARD "