Sabotage or suicide?
Posted: Tue Dec 04, 2012 1:32 pm
The 'refusenik' governors are throwing away a chance to set up their own insurance exchanges in the best way for their citizens and keep the regulation as local as possible in order to try to destroy the only broadly effective health care reform we have had in decades.
Are the Republican governors going to sabotage Obamacare (and hurt their citizens once again to serve partisan pissiness.) or are they committing political suicide? Romenycare in Mass. is hugely successful and when the same program rolls out in other states the effect will be similar. Will the citizens of 'refusenik' states resent the Republican's desire to keep them sick and poor or will they go along with it?
_____________________________
http://www.washingtonmonthly.com/ten-mi ... 041545.php
December 03, 2012 11:00 AM Can the States Sabotage Obamacare?
By Greg Anrig
Facebook Twitter Digg Reddit StumbleUpon Delicious
After surviving near-death experiences on Capitol Hill, in the Supreme Court, and during the presidential election, the Affordable Care Act is now confronted with unanticipated sabotage in conservative state capitols. The passive aggression of many Republican governors and state legislatures, who are balking at implementing key elements of the law, threatens to create severe political blowback against health care reform upon its launch in a little over a year while undermining the effectiveness of the legislation. Policy analysts always recognized that relying heavily on states to administer the act posed major challenges, but the unexpected depth and breadth of state-level resistance has created the real possibility of a fiasco come 2014.
Until recently, supporters of health care reform looked to the experience of Medicaid’s original implementation for reassurance that states will quickly fall in line to carry out major federal health care legislation. Within just two years after federal funds became available for Medicaid in 1966, 37 states agreed to participate, and all except Alaska and Arizona joined in after four years. The presumption among most Affordable Care Act supporters was that contemporary resistance to health care reform would similarly subside before too long as Republican governors and legislatures recognize that they and their constituents have too much to gain from embracing the law.
But the Affordable Care Act is a far more ambitious and complex piece of legislation than the original Medicaid law was, and its rollout is occurring under more inhospitable political conditions. Obamacare extends coverage to the uninsured through two main channels, both of which were intended by Congress to intimately involve the states. One of those is expansion of Medicaid, the state-administered insurance program for low-income Americans and nursing home residents that is jointly financed by the federal and state governments. The other main mechanism for extending coverage is through the creation of so-called insurance exchanges, which are governmentally organized and regulated marketplaces where uninsured Americans and small businesses can shop for health plans while paying premiums that will be partially covered by the federal government. Congress and the act’s designers expected that most states would be eager to develop and manage the exchanges to maintain greater control over how they operate, though the law also provided that the federal government could either step in where states declined to run the exchanges or set them up jointly with states that preferred a hybrid approach.
On both the Medicaid and insurance exchange fronts, unforeseen developments have greatly impeded progress. The Supreme Court erected the surprise Medicaid hurdle in Chief Justice John Roberts’ ruling upholding the constitutionality of the Affordable Care Act but allowing states to opt of the legislation’s requirement to extend Medicaid coverage to Americans with incomes up to 138 percent of the poverty level. That decision opened up an escape hatch that eight states with Republican governors have already jumped through and another five are leaning toward. Only twelve states have so far agreed to accept the broadened Medicaid eligibility levels, with four more leaning in favor. Fully 21 states remain completely up in the air about Medicaid expansion. Even though the federal government would pay for almost the entire cost of expanding Medicaid, and states would likely end up saving money due to reductions in what they currently owe to medical providers for non-Medicaid uncompensated care, it is plausible that more than half the states will be opting out when health care reform takes effect in 2014. Although the main explanation from the recalcitrant states has been that they simply can’t afford to take on any additional outlays, providing health insurance to the poor has never been a high priority in conservative parts of the country.
Even worse from the standpoint of feeding public hostility to the law are the roadblocks that have emerged to rolling out the insurance exchanges. In many respects, uninsured citizens will form their judgments of health care reform based on their experiences with those exchanges, much as taxpayer views about government are shaped by their interactions with motor vehicle departments, the Internal Revenue Service, and post offices. While exchanges have often been analogized to commercial websites like Expedia.com, they are far more elaborate operations requiring a regulatory apparatus to, for example, make determinations about which plans to include and exclude from the exchanges. Another central goal of the exchanges is to minimize “adverse selection,” which arises when certain plans, or the entire exchange, enrolls a relatively high-cost group of beneficiaries that leads to escalating premiums in those plans. Preventing and responding to adverse selection is an enormously difficult regulatory challenge that is essential to keeping the new system from unraveling. In addition, health insurance plans are inherently complicated, so developing user-friendly interfaces to clearly present options to consumers will be critical to minimizing aggravation and enabling people to make sensible choices. Moreover, the exchanges are the mechanisms by which consumers are supposed to be able to learn the amount of their government subsidies for premiums and whether they are eligible for Medicaid.
..... see link for more,
_____________________________
yrs,
rubato
Are the Republican governors going to sabotage Obamacare (and hurt their citizens once again to serve partisan pissiness.) or are they committing political suicide? Romenycare in Mass. is hugely successful and when the same program rolls out in other states the effect will be similar. Will the citizens of 'refusenik' states resent the Republican's desire to keep them sick and poor or will they go along with it?
_____________________________
http://www.washingtonmonthly.com/ten-mi ... 041545.php
December 03, 2012 11:00 AM Can the States Sabotage Obamacare?
By Greg Anrig
Facebook Twitter Digg Reddit StumbleUpon Delicious
After surviving near-death experiences on Capitol Hill, in the Supreme Court, and during the presidential election, the Affordable Care Act is now confronted with unanticipated sabotage in conservative state capitols. The passive aggression of many Republican governors and state legislatures, who are balking at implementing key elements of the law, threatens to create severe political blowback against health care reform upon its launch in a little over a year while undermining the effectiveness of the legislation. Policy analysts always recognized that relying heavily on states to administer the act posed major challenges, but the unexpected depth and breadth of state-level resistance has created the real possibility of a fiasco come 2014.
Until recently, supporters of health care reform looked to the experience of Medicaid’s original implementation for reassurance that states will quickly fall in line to carry out major federal health care legislation. Within just two years after federal funds became available for Medicaid in 1966, 37 states agreed to participate, and all except Alaska and Arizona joined in after four years. The presumption among most Affordable Care Act supporters was that contemporary resistance to health care reform would similarly subside before too long as Republican governors and legislatures recognize that they and their constituents have too much to gain from embracing the law.
But the Affordable Care Act is a far more ambitious and complex piece of legislation than the original Medicaid law was, and its rollout is occurring under more inhospitable political conditions. Obamacare extends coverage to the uninsured through two main channels, both of which were intended by Congress to intimately involve the states. One of those is expansion of Medicaid, the state-administered insurance program for low-income Americans and nursing home residents that is jointly financed by the federal and state governments. The other main mechanism for extending coverage is through the creation of so-called insurance exchanges, which are governmentally organized and regulated marketplaces where uninsured Americans and small businesses can shop for health plans while paying premiums that will be partially covered by the federal government. Congress and the act’s designers expected that most states would be eager to develop and manage the exchanges to maintain greater control over how they operate, though the law also provided that the federal government could either step in where states declined to run the exchanges or set them up jointly with states that preferred a hybrid approach.
On both the Medicaid and insurance exchange fronts, unforeseen developments have greatly impeded progress. The Supreme Court erected the surprise Medicaid hurdle in Chief Justice John Roberts’ ruling upholding the constitutionality of the Affordable Care Act but allowing states to opt of the legislation’s requirement to extend Medicaid coverage to Americans with incomes up to 138 percent of the poverty level. That decision opened up an escape hatch that eight states with Republican governors have already jumped through and another five are leaning toward. Only twelve states have so far agreed to accept the broadened Medicaid eligibility levels, with four more leaning in favor. Fully 21 states remain completely up in the air about Medicaid expansion. Even though the federal government would pay for almost the entire cost of expanding Medicaid, and states would likely end up saving money due to reductions in what they currently owe to medical providers for non-Medicaid uncompensated care, it is plausible that more than half the states will be opting out when health care reform takes effect in 2014. Although the main explanation from the recalcitrant states has been that they simply can’t afford to take on any additional outlays, providing health insurance to the poor has never been a high priority in conservative parts of the country.
Even worse from the standpoint of feeding public hostility to the law are the roadblocks that have emerged to rolling out the insurance exchanges. In many respects, uninsured citizens will form their judgments of health care reform based on their experiences with those exchanges, much as taxpayer views about government are shaped by their interactions with motor vehicle departments, the Internal Revenue Service, and post offices. While exchanges have often been analogized to commercial websites like Expedia.com, they are far more elaborate operations requiring a regulatory apparatus to, for example, make determinations about which plans to include and exclude from the exchanges. Another central goal of the exchanges is to minimize “adverse selection,” which arises when certain plans, or the entire exchange, enrolls a relatively high-cost group of beneficiaries that leads to escalating premiums in those plans. Preventing and responding to adverse selection is an enormously difficult regulatory challenge that is essential to keeping the new system from unraveling. In addition, health insurance plans are inherently complicated, so developing user-friendly interfaces to clearly present options to consumers will be critical to minimizing aggravation and enabling people to make sensible choices. Moreover, the exchanges are the mechanisms by which consumers are supposed to be able to learn the amount of their government subsidies for premiums and whether they are eligible for Medicaid.
..... see link for more,
_____________________________
yrs,
rubato