Tuesday, November 20, 2012

On The Road To Single Payer

All those Republican governors who railed against government-run healthcare back in 2010 are making it come true, at least in their states.

Late last week more than a dozen Republican governors declared that they will not build the insurance market exchanges called for by the Affordable Care Act, including prominent names like Bobby Jindal of Louisiana, John Kasich of Ohio, Scott Walker of Wisconsin and Rick Perry of Texas.

On Monday, Gov. Mary Fallin of Oklahoma joined them, declaring in a statement that it “does not benefit Oklahoma taxpayers to actively support and fund a new government program that will ultimately be under the control of the federal government.”

The original deadline for states to notify the Department of Health and Human Services on whether they intend to build their own exchange was last Friday, but the administration extended it to Dec. 14. About a dozen Republican governors are weighing their options, including Chris Christie of New Jersey, Rick Scott of Florida and Terry Branstad of Iowa.

The Affordable Care Act encourages each state to build and operate its own exchange — a regulated, subsidized marketplace where consumers and small businesses can shop for insurance plans. If a state declines, the federal government has the power under the health care reform law to build one for it.

The decisions carry important implications for the long-term arc of Obamacare, which supporters and opponents alike agree is here to stay now that President Obama has been re-elected. The Obama administration wants states to build the exchanges so they have an incentive to make the law work. If the federal government takes over, state-level Republicans have a scapegoat in case things go wrong.

There’s no telling how it will work out; different states have different needs, and HHS can only do so much, but if it works as well as Medicare, it might be better than what the states can come up with on their own despite all the rhetoric about “local control.”

What I think is both troubling and predictable is that these governors are willing to put a lot of their citizens’ health and well-being at risk just to score political points with their re-election base (hi, Gov. Rick Scott of Florida).  How many people have to get sick and die quickly for him to avoid getting primaried by a teabagger?

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