The new law authorizes the secretary of health and human services to provide grants to states for them to create health insurance exchanges that must conform to yet-to-be-written federal regulations. The law also authorizes the HHS head to establish and run the exchanges unilaterally should any state choose not to create an exchange by Jan. 1, 2014.
This would seem to put governors opposed to the law in a tough bind:
Do they accept the federal money and attempt to design an exchange that does the least amount of harm to residents of their states? Or do they defy Obamacare, refuse the money and implement their own consumer-friendly reforms? But this is a false choice.
Just look at the history of any federally funded state-run program. Whether it is Medicaid, education or transportation, the pattern is clear: Once states accept funding from the federal government, they quickly become dependent on it, and are forever at the mercy of red-tape-happy bureaucrats in Washington. HHS will be writing all the rules that govern each of the state exchanges, so who actually administers them is largely irrelevant.
So far, only Govs. Sean Parnell, R-Alaska, and Tim Pawlenty, R-Minn., have turned down federal money for funding Obamacare exchanges. That means 48 governors chose to accept the money. They include many with strong conservative track records like Haley Barbour of Mississippi, Sam Brownback of Kansas, Mitch Daniels of Indiana, John Kasich of Ohio and Scott Walker of Wisconsin.
But momentum is changing. After Judge Roger Vinson found Obamacare unconstitutional in January, Florida Gov. Rick Scott rejected $2 million in previously awarded federal grants and halted all implementation efforts. On March 16, Gov. Nathan Deal pulled legislation creating Georgia’s exchange system after protests from local Tea Party groups. And on the anniversary of Obamacare’s passage, Gov. Bobby Jindal announced that Louisiana would pursue its own health care reforms, none of which will include an Obamacare-compliant exchange system.
Even states with governors sympathetic to the law are finding implementation of the exchanges to be a headache. Sold by the White House as a simple clearinghouse like Travelocity, the Obamacare exchanges must collect detailed personal information such as family size, medical history, employment status and personal income. Such information is required to determine the amount of each family’s insurance subsidy. This is yet another reason why the U.S. Supreme Court should not delay in granting Virginia Attorney General Ken Cuccinelli’s request for an expedited review of his state’s challenge of Obamacare’s constitutionality.