WASHINGTON – Nineteen states have turned down the Obama administration’s invitation to run the new health insurance markets that will begin serving millions of uninsured Americans less than a year from now. That puts a huge responsibility on the feds, a defining challenge for President Obama’s second term.
Today is decision day for states to notify Washington whether they will set up their own insurance exchanges under the federal health care law. Monitoring by The Associated Press finds a divided nation moving ahead, despite the misgivings of some state officials. Half the states now say they will participate in some way.
Still, drafters of the law did not expect so many states to remain on the sidelines at this late stage. Federal control of the new state markets where individuals, families and small businesses will shop for taxpayer-subsidized private coverage was seen as a fail-safe, not the standard for nearly half the country. Critics predict delays.
All the states refusing are led by Republicans; among them is Indiana.
I do not believe the state of Indiana should establish a state-based health insurance exchange because doing so will cost taxpayers millions of dollars and it is not clear that Hoosiers would benefit from incurring the cost of implementing this new federal health care bureaucracy, incoming Gov. Mike Pence wrote to federal authorities last month.
On the other side of the ledger, 17 states and Washington, D.C., say they want to set up and run their own markets. The administration has already started granting approvals. Eight other states have indicated they want to pursue a partnership with Washington, and more may do so. Only six remain undecided.
Exchanges are supposed to make picking health insurance like buying an airline ticket from an online travel site like Orbitz or Expedia.
There will be a website, and you’ll be able to put in your ZIP code and get a list of available health plans. There will be a section where you can find out whether you qualify for subsidies or for Medicaid. There will be cost calculators to allow you to compare different levels of coverage: platinum, gold, silver and bronze. There will be tools that allow you to see whether your doctor or hospital is with a particular plan.
Open enrollment for exchange plans starts next Oct. 1, and coverage begins Jan. 1, 2014. Initially around 10 million people are expected to sign up, with the number growing rapidly thereafter. Republican governors rejecting state exchanges have cited a variety of reasons. Some say the administration has not provided enough information. Others say there’s too much federal regulation. Most have concerns about costs.
But some Republican leaders have broken ranks, including governors in Idaho, Nevada and New Mexico, and the insurance commissioner in Mississippi.
Indeed, exchanges have a Republican pedigree. The idea was pioneered in Massachusetts under then-Gov. Mitt Romney’s health care overhaul.
All this is full of irony, said consultant Jon Kingsdale, who founded the Massachusetts exchange for Romney. If you had asked many of those (Republican) governors four years ago before this got politicized, it would have been a no-brainer: We want the states to do it.’