The people of Vermont deserve congratulations and support for their years of grass-roots activity that could make this a reality as early as 2017. The only reason we don't have this nationwide is because of the corrupting power and influence of the pharmaceutical and insurance corporations.
If Vermont succeeds, other states and then the federal government could follow, as happened in Canada.
Mark Weisbrot is co-director of the Center for Economic and Policy Research.
No: let U.S. build flawed system and then duck consumers' flak
WASHINGTON — The post-election rollout of the Obama administration's plans to implement insurance exchanges in time for January 2014 enrollment has met substantial state government opposition, raised more questions than answers and flashed warning signs of a train wreck ahead.
Thirty-three states — a clear majority — still are not fully on board with running their own exchanges to comply with the dictates of the Affordable Care Act. Most of those states — as many as 23 — would rather leave the daunting implementation process entirely in the hands of federal officials.
The strong resistance of many state governors — who are being asked to build the key regulatory architecture for Obamacare — is fully justified.
While it may simply be good short-term politics for Republican state officials looking to avoid the blame for ongoing complications and contradictions that were made in Washington, it should also reinforce a more principled strategy to support a better version of competition for diverse health insurance products.
The fuzzy sales rhetoric for ACA-style health exchanges masks their real nature. The blueprint for implementation of Obamacare goes far beyond the modest restructuring of problematic portions of the health insurance market.
The more ambitious political agenda includes three major goals:
Expanding the federal government's regulatory control over private health insurance,
Facilitating substantial income redistribution with new premium assistance subsidies,
Establishing greater voter loyalty from constituencies increasingly dependent on government-brokered channels for health care.
The ACA's architecture adopts only the appearance, but not the reality, of private sector delivery and state government administration in order to disguise and carry out most of this radical takeover plan.
State-administered health exchanges are key mechanisms to enforce mandates requiring employers to provide ACA-approved coverage, and individuals to purchase it. The exchanges will have every incentive to limit competition from private market alternatives. They also will place maximum emphasis on expanding enrollment in an unreformed Medicaid program.
The Obama administration insists it can deploy initial versions of exchanges run by the federal government in holdout states in time for 2014. But the ability to put in place systems to coordinate the flow of integrated data necessary for eligibility and payment operations, let alone for adequate customer service, remains questionable.
The White House desperately needs the infrastructure and experience of state-level officials to pull off an unprecedented nationwide rollout. And it wants state governments to serve as political heat shields to absorb most of the blame and burden for what is likely to go wrong.
State opponents of ACA-style exchanges should go beyond complaining about unclear rules and high costs.
First, they should support the litigation strategy of the state of Oklahoma, which is challenging in federal court the validity of an Internal Revenue Service rule that authorizes federally run exchanges to distribute ACA premium assistance tax credits to their enrollees.
Second, for an alternative version of coverage expansion in states, governors should insist on mechanisms that are simpler, more consumer-friendly and scaled back to work within existing capabilities and institutions.
If state opponents of ACA exchanges decline to be merely tax-collecting branch offices for the federal welfare state's new insurance mandates, they can force federal officials to return to the negotiating table with states and their constituents as equal partners.
Thomas P. Miller is a resident fellow at the American Enterprise Institute.
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