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Subscribe to RSSAfter 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 -- even after a last-minute deadline extension.
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.
Thursday evening, the Obama administration responded to a request for more time from Republican governors by granting states a month's extension, until Dec. 14.
Ahead of the original deadline, a check by The Associated Press found that 21 states plus the District of Columbia, have already indicated they want to become involved, either by building and running their own exchanges or partnering with Washington. The 16 that want to build their own exchanges, plus the District of Columbia, have a Jan. 1 deadline for the federal government to approve their plans.
This group of 16 includes mainly Democratic-led states such as California and New York, but also some Republican-led ones such as Mississippi and New Mexico.
Five other states have signaled they want to partner with the federal government. Those states would handle consumer issues and oversight of health plans in the exchanges, while the feds do the heavy lifting by enrolling individuals for coverage and determining who's eligible for government assistance. Among these states are Arkansas and North Carolina.
The number of partnership states could grow significantly, since the Obama administration has given states until next February to decide on that option. As of Thursday, 16 states indicated that they were weighing their options and have not made a final decision.
Among those, Ohio and Tennessee were considering the partnership route. And in Florida, Republican Gov. Rick Scott is now saying he wants to find a way to work with the federal government after years of steadfastly opposing Obama's overhaul.
Finally, 13 states have indicated they will default to the federal government, allowing Washington to set up and run their exchanges. The health care law provided that the feds would run exchanges in states that were not ready or willing to do so. In this group are states whose Republican governors have staunchly opposed the law, including Texas, Louisiana and South Carolina.
Obama's election victory guaranteed the survival of his health care law, which is eventually expected to provide coverage to more than 30 million people through the exchanges and expanded Medicaid programs. It was the final hurdle, after the Supreme Court upheld a legal challenge from 26 states. In the aftermath of the election, some Republican state leaders say it's time to accept the law.
"I don't like it; I would not vote for it; I think it needs to be repealed. But it is the law," said Mississippi Insurance Commissioner Mike Chaney, after announcing that his state wants to set up its own exchange. "If you default to the federal government, you forever give the keys to the state's health insurance market to the federal government."
Traditionally, states have regulated the private health insurance market.
But other Republican-led states say they don't have enough information to make a decision at this point and are clamoring for the Obama administration to release major regulations that have been bottled up for months.
"States are struggling with many unanswered questions and are not able to make comprehensive far-reaching decisions prudently," Govs. Bob McDonnell of Virginia and Bobby Jindal of Louisiana wrote Obama earlier this week. They asked for a meeting with the president, as well as a postponement of the original Nov. 16 deadline.
Some of their main concerns are hidden costs of operating the exchanges and the sheer bureaucratic complexity of the new system. The Obama administration has steadfastly maintained it will not postpone the Jan. 1, 2014, launch date for the law's coverage expansion. Open enrollment for exchange plans will begin even sooner, Oct. 1, 2013.
Policy experts in Washington are noticing the shift.
"I think it's a very practical decision for states now," said Alan Weil, executive director of the nonpartisan National Academy for State Health Policy. "We are going to have a significant number of states running their own exchanges, a significant number where the federal government is running the exchange and a significant number of partnerships. The bottom line is, we are going to have to figure out how to make all three models work."
Although the public remains divided about the health care law, the idea of states running the new insurance markets is popular, especially with Republicans and political independents. A recent AP poll found that 63 percent of Americans would prefer states to run the exchanges, with 32 percent favoring federal control.
The breakdown among Republicans was 81 percent to 17 percent in favor of state control, while independents lined up 65-28 for states taking the lead. Democrats were almost evenly divided, with a slim majority favoring state control.
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As long as it is implemented in some manner, it's good to see the states realizing that it's time for all Americans to have health insurance. Perhaps some time in the future it will be universal and that a single-provider option will become available.
Left Wing Nut Job
Nut Job, I am a Republican, never have I voted for a democrat and I am 60 years old. That being said, you are absolutely right. Our health care system is terrible compared to other industrialized countries. For people to say the British, Canadian, Australian, etc health care systems are bad, should look at the life expectancy and health of citizens in those countries and the cost per person to provide health care. Some say there are waiting periods for non emergency care under those types of systems, maybe so, but there is here too.
Simple question: we didn't have the money for the wars in Iraq/Afghanistan. If Bush ruined us by going into debt to pay for these wars, then how did we suddenly have the money to pay for it now?
It isn't a question of having health insurance, it is a question of DEMANDING health inusrance for all, and charging the bill to our kids and their unborn kids.
Some people will give their lives for their country. Others will suck it dry and make their kids pay for it. Which one are you?
Apparently, you are one that would prefer that the country be "sucked dry," as you put it. Lovely right wing talking points...completely bogus, but you folks apparently don't care.
In the end, we all pay for people that don't have insurance. If folks don't have insurance, then we get to enjoy the "benefits" of that lack of insurance. They don't take advantage of preventative care, as they cannot afford it, so they wind up getting sick with something that might have otherwise been prevented. Then, since they don't have insurance, they wind up in the emergency room; the uninformed view this as free health care, except we all wind up paying for that "free" care. Also, their children don't get care so they get sick, or get to a level of illness they might otherwise avoid. Some of these sick kids become disabled from illnesses that would not have progressed that far otherwise, so they wind up on permanent welfare - but I suppose you don't think we pay for that, either.
The right, whining about their ideology instead of simply using common sense, show that they care little about their fellow citizens. They put that ideology above the good of the country and try to pass it off as patriotism. These people are frauds and are as far from patriotic as possible. Wake up.
Left Wing Well said. People should realize that we have the worst insurance of all of the industrialized countries. I have heard that competition among health care providers will cover that. We have tried that for over 60 yrs. It has not worked. People who do not have insurance get sick and go to the ER. Who pays for that?? Romney takes great pride in Romneycare. It was not his idea to begin with. Ted Kennedy fought for health reform for many years because of his son that had to have a leg amputated. Ted saw how much it would cost for someone without insurance.
I live in Alabama where the governor, a retired dermatologist, has notified the federal governmen that Alabama will permanently default to the federal exchanges. By doing to the state permanently gves up all rights and future input. The governor currently does not accept a salary from the stae because this frees him from having to follow state ethics rules on such things as bribes and gifts. Since 97% of he health care insurance business in Alabama is controlled by one company (Able Insurance) that is financially connected to the governor, I cannot help but wonder at the possible flow of money in this case.
I'm a small business owner in Wisconsin and I'm thrilled that our teabagger governor opted out since the feds will do a far better job implementing the exchanges than he would.
Obamacare has already had a direct positive impact on our bottom line since our premium increases this year were less than 5%, far smaller than the 20% to 30% we've had for most of the past 10 years.
@Chris - I'm flabbergasted.
I live in Florida, Rick Scott's wasteland. I thought he was a POS governor, owning health companies that paid hundreds of millions to the Federal govt. in fines, etc. for their fraudulent Medicaid billing; just before he ran for office.
I'm just a layman, but how the f$@k&;g hell does crap like that become law??
Why have WE, the American citizen/consumer/worker/voter etc. allowed these things to happen?
It is past time to take back our country. From BIG BUSINESS.
This is supposed to be a government "by and for the people".
It has for too many years been a government 'by and for big business'. That must change.
Big business has long since forgotten that, we, the American people are the primary source of their riches.
We need a different type of 'tea party'. One that will take these corporate big wigs and throw them into Boston harbor.
If you had paid attention to the Tea Party, you would have realized what they wanted about government would have crossed into big business also. But you probably fell for the propaganda about them being rascist and so forth. You have to chop the head off before you can go after the corporations. The head being the corrupt government. Someday it will all click, but sadly, it will be too late.
The "Tea Party" is funded by big business. Talk about propaganda.
The Teabaggers STILL don't realize how they were being manipulated by the big insurance companies and other big business special interests.
I am with the states not sitting up the exchanges, what are the rules? who will bear the cost? what coverage is required? What will really heppen is that more will be put on Medicad and neither the Fed or the State have the money to pay for it.
Insurance companies rake a high percentage of the premiums off the top. Too bad the insurance companies didn't get the axe with all this. All along the American citizens pay twice as much per capita for health care as the next industrialized nation does, yet we don't insure 50,000,000 of our citizens. Where is the money going? Most hospitals are always about to go under, health care professionals (except for doctors) are just making a normal living. The big benefactors of a health care system like the US has is big drug companies and the insurance companies. Just for the record, I am a Republican.
Until right before the great recession I was a manager for an automotive parts manufacturer in PA. We made 4 or 5 shipments a day of parts to Canadian assembly plants. The drivers were always Canadian. I asked many drivers the open ended question about their health care: 'What do you think of Canada's health care solution?'. Not a single driver criticized the system. One said that his wife had to wait almost a year for elective surgery, but every single driver liked the system. Another said the providors were given tort reform so that lawyers can't file frivolous lawsuits. Drivers indicated the coverage is affordable and provides good coverage to all.
I have been to Canada. You pay a high sales tax. I don't know if that's how they fund the system. I do know their system should be extensively reviewed to see what they do right. And everybody should stop listening to the Fox News BS (especially Bill O'Reilly) about Canadians hating their health care coverage. They say 'You wont get coverage in an emergency. You won't have choice'. Not true.
By the way, I am a self-employed 55 year old Republican (former - won't vote for the likes of the current group of misfits until they nominate a middle-of-the-roader) who thinks a good single payer system is what this country needs.
You can't read any article on Mcare or Medicaid without seeing the words 'fraud' or 'over-budget' in them. The system has been wildly mismanaged from day one.
How about the government PROVE it can run those programs BEFORE it attempts to run a program for teh entire country? Is that really too much to ask?
You are pretty good at posting dreck... How about being realistic and doing a little real research (that would preclude Beck, Limbaugh, Fox, etc.) and then tell us what the administrative costs off Medicare are versus those of your heros, the private insurers. By the way, Obamacare uses private insurance, unfortunately, so your bogus rant about Medicare and the like is moot anyway.
The health care in Canada is not bad at all. Yes for certain things there are wait times, but they are not going to let you die on the floor if you need attention right away. The health care system is indeed one reason for the higher sales tax, but there are also family programs such as child allowance, where parents get a few hundred or so dollars for ea child they have to help them offset costs of raising children.
Then again in a land where you pay $6 a gal for milk and where gas is also almost $6, your glad to get the type of help from the Gov. Also, contrary to popular thought in the US. Social programs that result in money being given back to the people DO NOT always lead to lazy people who do not want to work. There are more examples of how the child credit and other social programs in Canada have produced working productive people then there are examples ( from my experience ) of people who take advantage of the Gov.
Are these social programs right for the US? Probably not so much, but there is one thing that is right for the US.. That is citizens that care about other citizens well being enough to make sure that they have access to at least basic things. It should be a right to have a basic life. If a person wants more, they should have to work for it and many actually do.
In WI, Governor Walker(R) has turned his back on the Wisconsin Mnf's Association, the Health Insurers, Hospital Associations, etc. (All supporters of his in the past) and answered the "open clarion call" of the right wing TParty extremists by refusing to set up a State Exchange. This follows his persistent and irrational battle against President Obama and, by extension, the AHCA, as he pursues his fantasy to be a presidential candidate in '16. While ignoring the health care and business interests in the State in regard to this issue, he has refused the $39 million dollars of federal money (WI taxpayer money not now being returned to this State) allocated to set up the Wisconsin Exchange. In addition, the Milwaukee Journal Sentinel reported on 11/13/12 that nine Republicans in the Legislature told the tea party group, Campaign for Liberty, they would back state legislation to arrest federal officials who took steps to implement the Affordable Care Act in Wisconsin. Pretty cheeky for a party which could not even carry WI for Romney/Ryan! Sedition anyone.
Actually it's a very good thing that Walker opted out, since he would have done a half-assed job implementing the exchanges. Far better for the feds to do it.
I don't care who runs the exchange, all I know is that I will be able to semi-retire at age 55, 4 years from now, thanks to taxpayer funded healthcare. Gonna find me a 20 hour a week job mowing lawns, and play golf (drink beer) the rest of the time.
Thank you, thank you, thank you.
I would suggest you do a little research prior to making any plans...you obviously haven'd done any up to this point (listening to Fox News, Beck, Limbaugh, et all, is NOT research).
I'm glad you've saved up enough or have a private pension plan generous enough to allow you to semi-retire at 55. At age 51 now, early-partial SS won't be available for 11 more years. If you're willing to wait until you can draw the full benefit, that will be 16 years until age 67. Once you start drawing partial benefits, you will never be able to draw the full benefit, except under special conditions that hardly anybody meets. Once you pull that trigger to start drawing partial benefits, your chance to draw full benefits is gone.
Looks like the Republicans are beginning to realize that they got whooped big time, and like the liars they are all the ones who said "Never!" now are saying "Where do we sign-up!", really . . .
Really! :-o
I had a family member under my care for a few years and the state mandated insurance through their government run programs. Very few doctors of quality would take the state insurance because they said rarely did they get paid. Also, the wait for doctors who would take the government insurance was hours in the office. Think Secretary of State wait times when you think of government run health insurance. And remember, the government has no money except for what they take from tax payers. Taxes will go up to provide health care to so many uninsured.
As much as I'm for this legislation the author of this article is wrong (and he and his EDITOR should have know that) "Obama's election victory guaranteed the survival of his health care law, which is eventually expected to provide coverage to more than 30 million people through the exchanges and expanded Medicaid programs." is not true....Obama being re-elected does not mean the law wouldn't be reviewd, or that if it was reviewed that a pocket veto would have quashed the review...if the house and senate had gone republican they could have over-ridden the president and nixed this piece of legislation....just thought you should know
While not perfect this is the only chance i have at getting medical car for my injury. This wouldnt even be needed if health insurance companies were not allowed to deny because someone has an injury through no fault of their own, and if health insurance companies were not the only gate keepers to access to medical care. What is truly needed is a single payer system, and get rid of this bs for profit model that directly conflicts with a person's need for medical care. Australia, Canada, France, Britain all have single payer systems. According to the people i have spoken to in these countries there is little to no waiting period and they say they get better medical care than we in US get. They also say that the term pre-existing condition is unique to America.
It all sounds too good to be true. Critical times hard to deal with, will be here.
Not here in Maine....luckily we have a true blooded American governor who will stand up to the dems fanatical ignorance.
Unless you live in my state: Texas.
my moron for a governor rather play with his glad handing health care lobbyist friends then actually help the people in this state, which I might add is 47th out of the 50 states in over all health care.
Glad that you have him and not the rest of us.
Health insurance exchanges. The heart of the Affordable Health Care scam. Guaranteed profits for insurance companies while limiting their cost. They will not need to do marketing because everyone is required to buy insurance and the plans are regulated to point where there are no appreciable differences. Will you get to keep your doctor? Maybe, but if you are a high risk patient, you know, the ones who benefit the most from continuity of care, don't count on it because the high risk pools will be distributed equally among the exchange insurance companies, same as assigned risk auto insurance for bad drivers.
Just let Amazon run it. They are experts at doing retail fulfillment at low cost.
Boycott ALL business with companies in states that establish these marketplaces.
Every confrontational TEA-Republican governor should not get any extensions of implementation of the Health Insurance Exchanges. The federal government should take over and make the government larger just what the TEA fringe barks about. The federal government will probably do a better job than any local politician would. Ted Cruz will fail Texas and Texans when he falls in line with the fringe extremist who put him in office. He is fully owned by these elements and as such will not get close to the trough of money. Further, his backing of TEA-Republican stances on the PPACA and implementation of the Health Insurance Exchanges will drag Texas and Texans down. Cruz will have to turn a hard left to get anything for Texas or Texans.