Wednesday, July 30, 2014

My turn: States looking to exchange Obamacare’s insurance exchanges

December 04, 2012 |

The next act in the Obamacare saga is about to begin — and it’s going to be tragic. Dec. 14 marks the deadline for states to reveal their plans for constructing insurance exchanges in line with the healthcare law’s dictates.

Many are opting out — leaving the federal government to set up exchanges for them. Others simply aren’t ready to establish their own.

And so these central components of Obamacare will soon stand as the latest examples of the president’s failure to make health insurance more accessible or affordable.

Obamacare’s insurance exchanges were intended to be state-based marketplaces where individuals and small businesses could choose from an array of coverage options. In theory, this structure would encourage states to experiment — and to tailor their offerings to the unique needs of their populations.

But in reality, the exchanges are burdened with so many rules that experimentation and competition have been stifled. Given the cost of setting up an exchange — and of complying with all the federal regulations — it’s no surprise that many states are refusing to participate.

According to a new report from PricewaterhouseCoopers, just 13 states and the District of Columbia have formally declared their intention to set up exchanges. Eight have said that they will not do so.

Many states planning to build exchanges will not be ready for enrollment by October 2013, when Obamacare requires them to be.

The reasons are manifold. For one, states are struggling with the design and implementation of the complex technology systems needed to run exchanges — especially in less than a year. California, the first state to move forward with an exchange, didn’t even lock down a vendor to do its IT work until May 2012.

States are also facing difficulty meeting Obamacare’s regulatory deadlines. Most have had trouble figuring out, for example, which “essential health benefits” must be included in insurance plans sold through their exchanges. The federal government did not decide until late 2011 that states would have to take on this responsibility. As a result, only 20 states met this year’s Sept. 30 deadline for submitting their vision of essential benefits to federal regulators.

And even if states are able to come up with essential benefits rules, they may be unable to attract any insurers onto their exchanges. Many insurance firms have stated that they may not be able to economically sell health plans through the exchanges if the required essential benefits are too generous.

President Obama need only look out his window to see how the insurance exchange drama is playing out. In the District of Columbia, small businesses are openly revolting over the city council’s requirement that all employers with fewer than 50 workers purchase their health plans through the District’s government-run exchange. The city has effectively eliminated the private small-group insurance market.

D.C. businesses see the folly in forcing a one-size-fits-all solution on their employees. The government-certified plans will have to cover all sorts of additional healthcare services that beneficiaries may not want — and will therefore cost more.

And then there’s the issue of money. Nobody knows for sure how much the exchanges will cost.

Several states have received federal grants to construct their exchanges. But once that money runs out, states will be on their own.

Minnesota, for instance, projects that it will have to come up with as much as $40 million in 2015 to run its exchange.

The Supreme Court’s decision this summer to allow states to opt out of Obamacare’s prescribed Medicaid expansion makes things even more complicated.

Several states have said that they won’t increase Medicaid enrollment. Residents who thought they’d sign up for Medicaid may instead turn to the exchanges. But coverage delivered through the new marketplaces will end up costing the federal government 50 percent more than it would have through Medicaid.

So the exchanges could grow far more expensive than initially thought — and quickly.

It’s safe to say that a federal mandate flouted by half the states doesn’t enjoy widespread support. That’s exactly the case with Obamacare’s health insurance exchanges — and it’s indicative of the broader failure of the president’s healthcare law.

Sally C. Pipes is president, CEO and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her latest book is The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery 2012).





District 2 candidate statements tell of goals

By Dawn Hodson | From Page: A1

Sand Fire nears containment: 66 structures destroyed

By Cole Mayer | From Page: A1 | Gallery

Schedule for Highway 50 blasting closures

By News Release | From Page: A3

Tails wagging over dog park approval

By Julie Samrick | From Page: A3

Quarter-acre fire in Kelsey

By Rebecca Murphy | From Page: A3



My Turn: Privatization of public services

By Mark Belden | From Page: A4

Policy book

By Mountain Democrat | From Page: A4



Piano replaced

By Letters to the Editor | From Page: A5

Comments sign-in policy

By Letters to the Editor | From Page: A5, 1 Comment

Save the Guinea Worm

By Letters to the Editor | From Page: A5, 1 Comment

Large bangs

By Letters to the Editor | From Page: A5, 2 Comments

Private property gets no respect

By Letters to the Editor | From Page: A5, 2 Comments

GDPUD management report

By Letters to the Editor | From Page: A5

District 2 supervisorial special election

By Letters to the Editor | From Page: A5, 4 Comments



Ex-Bruin lends a helping hand

By Steven Shaff | From Page: A8 | Gallery

Sierra Sharks finish middle of the pack

By Democrat Staff | From Page: A8

Roundup: July 29, 2014

By Democrat Staff | From Page: A8

Taz pull through for SSL trophy

By Patty Pope | From Page: A8



Nuns discover a pleasant place

By Lexi Boeger | From Page: B1 | Gallery

Bargains can be found everywhere

By Democrat Staff | From Page: B2 | Gallery

At a glance: Game time

By Mimi Escabar | From Page: B2

Barbecue dinner to benefit Blue Star Moms

By Mount Aukum Winery | From Page: B2

Stagecoach story takes riders on a trip

By Wendy Schultz | From Page: B3

Help needed to make cool ties

By Sew 4 | From Page: B3

Stroke and osteoporosis screenings planned

By Life Line Screening | From Page: B3

Gold Rush Days activities cancelled this year

By Sacramento Convention And Visitors Center | From Page: B4

Master Food Preservers: Tomato time

By Monique Wilber | From Page: B4

Sacramento area museums offer summer fun

By Sacramento Association Of Museums | From Page: B5

Build an author platform at the Library

By El Dorado | From Page: B5



Weather stats 7-29-14

By Michael Raffety | From Page: A2

Building permits 6/2-6/2014

By Michael Raffety | From Page: A2Comments are off for this post

Crime Log: July 17

By Cole Mayer | From Page: A2



Merlyn Wilbur Adams

By Contributor | From Page: A2

Lisa Oliver Rose

By Contributor | From Page: A2

Wallace Murrel Thomas

By Contributor | From Page: A2


Real Estate




Women’s Health

Love the skin you’re in

By Noel Stack | From Page: WH4

Dump stress and improve your health, productivity

By Wendy Schultz | From Page: WH7Comments are off for this post

Women’s Health Expo

By Marshall Medical | From Page: WH8

Find the confidence you need to fight back

By Special to the Democrat | From Page: WH12

Our choices directly affect our health

By Special to the Democrat | From Page: WH14

They’re NOT your mother’s hearing devices!

By Marshall Medical | From Page: WH17