Stanley Feld M.D.,FACP,MACE
President Obama has an interesting
way of negotiating. Rather than trying to compromise and meeting some of the needs of the
opposition, he always plays a game of chicken at the last minute.
Most of his supposed
innovations have failed because of this.
He has backed off many of
his proposed innovations either because of resistance by opponents or because the
innovation was impractical.
The CLASS ACT (Community Living Assistance Services and Supports) was abandoned
by the administration because once it became apparent that providing long-term
care would be impractical, unaffordable and impossible to execute.
The same realization is
emerging for the formation of the health insurance exchanges (HIX). Health
insurance exchanges were supposed to be operational in every state on January
The traditional media continues
to play right into President Obama’s hands. It makes a battle between the good
guys and the bad guys out of every issue rather than presenting the facts about the
President Obama and his team
are always the good guys. All of the critical issues for success or failure of
the health insurance exchanges have been left out of the public debate.
President Obama’s idealistic
hope was that all the states would make their commitment to set up the
exchanges. Many states have refused to set up the health exchanges. President
Obama increased state subsidies for the exchanges without congressional
approval to encourage states to join.
By August 2012 only 13
states agreed to set up their own state health insurance exchanges. As of the
end of November 2012 only 17 states agreed to set up their own healthcare
The revised deadline of
November 15, 2012 for signing up has been extended to December 15, 2012.
States wanting to pursue a
"partnership exchange", a hybrid exchange to decrease costs to the
states by increasing Federal Funding still have until Feb. 15, 2013 to submit a
declaration letter and blueprint for its exchange.
Federal officials have
stated if states do not set up the exchanges the federal government will.
HHS was supposed to certify HIX blueprints for all 50 states by Jan. 1,
2013. The states are supposed to be ready for open enrollment by Oct. 1,
2013 and operational on Jan. 1, 2014.
As of November 19, 2012, seventeen states, NY, MA, RI, NH, DC, KY, DE, W
VA, MS. NM, CO, CA. OR, NV, MN, WA, and HI have declared their intention to establish
a State-based Exchange (SBE).
Federal regulations have not been released. I will bet some of above
states will drop out when they will be able to calculate their costs.
The nineteen states that have definitely declined to participate in the
health insurance exchanges at this point are TX, OK, KS, NB, ME, VT, SD, ND, AK
WY, MT, VA, GA, AL, MO, SC, OH, IN, WI.
Most of these states realize the financial burden, administrative
burden, and challenge to states rights Obamacare’s health Insurance exchanges
will place on their states as they try desperately to balance their own
An additional five states, AR, NC, Il, MN, and ME are pursuing an ill
defined partnership plan offered by the
Obama administration to set up a health insurance exchange.
Nine states are undecided but leading toward rejection.
A total of 28 states are leaning towaed total rejection of the health
insurance exchange concept and 22 states are interested.
I am not a Rick Perry fan but sometimes he says some smart things.
a 'state' exchange nor the expansion of Medicaid under the Orwellian-named
P.P.A.C.A. would result in better 'patient protection' or in more 'affordable
care,'" Texas Gov. Rick Perry said in July in a letter to
Health and Human Services Secretary Kathleen Sebelius. "What they would do
is make Texas a mere appendage of the federal government when it comes to
The administration has published preliminary regulations. Even though
the exchanges are supposed to be state run, the federal government is going to
dictate the rules. The loss of state rule is making many state governors
Gov. John R. Kasich of
Ohio, a Republican, said Friday that his state “will not run an Obamacare
health exchange, but will instead leave that to the federal government to do.”
“Based on the
information we have,” Mr. Kasich said, “states do not have any flexibility to
build and manage exchanges in ways that respond to unique needs of their
Gov. Scott Walker of Wisconsin said, “under
the law, Wisconsin taxpayers will not have meaningful control over the health
care policies and services sold to Wisconsin residents.”
Gov. Nathan Deal of Georgia, a Republican said, “his state would not establish an exchange. He expressed
concern about what he described as “the one-size-fits-all approach and high
federal burden imposed on states.”
It will be interesting to
see how President Obama is going to get around this problem. Especially when
the last CBO estimate of the cost of Obamacare will be $2.5 trillion dollars
over the next ten years rather than decreasing the cost of healthcare by $115
billion dollars over the next 10 as originally estimated.
This problem represents
just a fraction of the problems health insurance exchanges are facing.
I will cover some of the
other problems in my next blog. Stay tuned.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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