December 14 has come and gone — and President Obama's Patient Protection and Affordable Care Act — better known as Obamacare — has received a stunning blow.
State governments had until December 14, 2012 to decide whether or not they would build their own health insurance exchange, an online service that would allow individuals to purchase private health insurance if it wasn't provided for by their employees.
That date has now passed and the exchange has been rebuked by half the states — with 25 state governments refusing to participate in this critical component of Obamacare.
Their refusal won't stop exchanges in their states. Under the law, states that don't create the exchange can opt to have the federal government deal with this expensive task.
Only 18 states and the District of Columbia have agreed to build and manage their own exchange, while 7 other states have taken a middle course and will partner with the federal government to create their exchange.
Why have so many states opted out when it comes to the exchanges? Part of the reason is undoubtedly political.
Most of the states carried by Mitt Romney in the recent presidential election also happen to be those that are refusing to build their own exchange. That is no coincidence. These are states with populations that, generally speaking, would vote by clear majorities to repeal Obamacare if they were permitted to do so.
The elected governments in these states were plainly listening to their citizens when they decided to say no to a state-run health insurance exchange.
But there’s more to the story. A number of states that voted for President Obama in the recent election have also said no to an exchange (notably Florida, Pennsylvania, Wisconsin, Virginia, New Jersey, Ohio and New Hampshire). While politics may have played a role in the decision these states made, other factors came into play.
Gov. Chris Christie of New Jersey explained to Jon Stewart, host of "The Daily Show," why he vetoed an exchange that would have been run by his state: “Here’s the issue, and why I vetoed it. I’m asking [the Obama administration] a bunch of questions about how much this is going to cost and everything else, and they won’t answer my questions… I’m not going to do this now… The law permits you always to change back to a state exchange if you want to. And what I’ve said to them is… if you can’t give me all the information, you run it.”
Texas Gov. Rick Perry, who also nixed his state creating an exchange, echoed a similar sentiment earlier this month.
"The idea that you’ve got a state instituted exchange, but it has to be federally approved. So the fact is the federal government’s going to have to run these," Perry said. "And they don’t have the expertise, nor do they have the money."
Perry predicted the implementation of Obamacare is "going to be a disaster."
Whatever the reason behind the decision of 25 states to opt out of building and managing an exchange within their borders, a large challenge now confronts the Obama administration.
The authors of Obamacare did not anticipate this level of non-participation by the states (as shown by the absence of specific language in the law to address the possibility), but now the federal government will be forced to build and manage exchanges for half the states in the country.
If the White House is unable to rise to this unexpected challenge, it could mean that some of the states which opted out will not have an exchange operating by October 1, 2012 — the date all exchanges in the country are supposed to open for business. While the federal government has the financial means to build out the exchange infrastructure where it needs to, it may have difficulties managing the health insurance landscape in individual states, given the labyrinth of different mandates and regulations that separate one state from another.
Another potential problem looms on the horizon thanks to a mistake in how the Obamacare law was written by Congress. The specific language of the law says that a health insurance exchange run by a state is eligible to receive subsidies from the federal government, but it does not explicitly say that an exchange run by the Department of Health and Human Services is eligible to receive the same money.
Right now, the Internal Revenue Service is ignoring this inconsistency, but someone may eventually mount a legal challenge over the issue, leaving the matter for the courts to decide.
But the uncertainty of the exchanges will inevitably raise the question of whether Obamacare can be fully implemented, especially by 2014 when the individual mandate requires every citizens to have private health insurance or pay a fine.
Since Obama's signed the sweeping legislation on March 23, 2010, it's sustainability has experienced a rollercoaster of ups and downs.
With a little more than half of Americans consistently opposed to it since then, President Obama’s greatest legislative achievement has nonetheless endured, surviving a controversial Supreme Court decision that could have cut the legs out from under it and a national election that could have elevated Mitt Romney to the White House along with his promise to block the law’s full implementation.
With these large judicial and electoral hurdles overcome, ObamaCareis now moving full steam ahead towards January 1, 2014, when most of its most important provisions become operational.
All, however, is not smooth sailing, as resistance to the new law remains strong, especially within numerous individual states within the country. The controversy surrounding the creation and management of the new health insurance exchanges highlights like nothing else does this persistent opposition.
Health insurance exchanges represent the vital central nervous system of Obamacare. Once they are up and running, Americans will be able to go to a web site and select an insurance plan that meets their individual needs from a menu of coverage options.
The plans will be regulated, with each one required to provide so-called “Essential Health Benefits.” The exchanges are by definition online marketplaces for health insurance, but they also are structural magnets that will help integrate the many different components of ObamaCare together.
Note: the Kaiser Family Foundation has a great map of how each state decided… we may want to use this as a visual aid or make one of our own that shows the same thing. You can find it here.
Read Latest Breaking News from Newsmax.com http://www.newsmax.com/Newsfront/health-exchanges-obamacare-christie/2012/12/16/id/467964#ixzz2FGRK1wAH
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