December 19 2011
Will State-Level Health Insurance Exchanges Be Ready on Time?
Today in the Washington Post, "Concern Growing Over Deadlines for Health-Care Exchanges"
...Health-care experts are starting to ask whether the fallback federal exchange called for in the 2010 law will be operational by the deadline in states that will not have their exchanges ready.
"It will be an enormous uphill battle to get this thing launched on time,” said Robert Laszewski, a consultant and former insurance executive who is watching the effort closely. “They have a Herculean task, even if everyone was cooperating.”
Did you know that as many as 31 states may refuse to implement an ObamaCare exchange?
(Check out slide #9 of this fantastic presentation by James Capretta of Ethics and Public Policy Center.)
Wow, it's no wonder that there is concern over the preparedness of the exchanges. Surely it was not the federal government's plan to have to do so much of the legwork. If you've read the legislation, you know that the language of the statute was this (from Section 1311(b)(1) of ObamaCare):
Each state shall, not later than January 1, 2014, establish an American Health Benefit Exchange.
Oops! “Shall” doesn’t sound like a very “cooperative” word. It sounds like a mandate. There are a lot of words available in the English language that communicate a voluntary act. “States may” or “states choose” or “states have the option” are a few examples. But the law says that the states “shall.” Then it seems someone (realizing that forcing states to create exchanges is surely not within the Constitutional powers of the federal government) caught this mistake in Section 1311 and tried to fix it by adding in Section 1321(c). If a state chooses not to “elect” to set up an exchange, then the federal government “shall establish and operate” an exchange within that state.
States already tried challenging this provision in court, but the challenge was thrown out early by Judge Roger Vinson in Florida's northern district.
But now the federal government is faced with the task of setting up - potentially - 31 state-wide exchanges (or more), and monitoring in real time the income and insurance statuses of millions of people. Think they can do it?
Even if they can, they shouldn't. The health "exchange" debate has been raging for years, but state leaders, especially those in pro-ObamaCare states, should be reminded that government can't "set up" or create a marketplace. By its very nature, the marketplace is something that happens organically. It can be regulated and restricted by government, but policymakers would do well to remember that any government involvement in the health care "market" is just that: regulation and/or restriction.
Perhaps the well-meaning idea behind an exchange is to provide consumers with more information. This is good, considering that perfect information is one of the characteristics of a perfectly competitive market. But there's no reason the government has to be the information source. In fact, this creates winners and losers among insurers and various plans, as government often faces incentives to skew information for political purposes.
To the states that have said no to ObamaCare exchanges and grants, I say thank you. You are on the front lines of battle - not only in the fight against centralized health care, but in the fight to preserve state sovereignty in the face of an aggressive and arrogant federal scheme.