Health Exchanges Have Fans in Some States

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If you're a broker in California, things will not be any better for us if ACA is repealed. Of course we have no money to fund an Exchange but hey, that hasn't stopped California yet from doing stupid things.


By LOUISE RADNOFSKY

A handful of states say they are planning to press ahead and voluntarily implement a key part of the 2010 federal health-care law even if it is wiped out by the Supreme Court.

The Obama administration's law faced three days of skeptical questions from the court's conservative majority this past week, increasing the odds that part or all of the law will be struck down. The justices met Friday for their weekly conference, where they were expected to take a preliminary vote and decide how to issue their written opinions on the case, but they aren't expected to announce their decision until late June.
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The health-care overhaul requires that all states have a new insurance exchange where consumers can comparison-shop for policies. The law calls for them to operate like travel websites that sell airline tickets, allowing people to stack up policies next to each other and get plan details in simple terms.

The exchanges, set to take effect in 2014, are one of the most popular parts of the new law. States can run their own exchanges or let the federal government do it for them.

Officials in Rhode Island, California and Colorado—states where governors are broadly supportive of the law—say they plan to move ahead with their exchanges even if the entire law gets struck down. They added that they expect the law will remain in place, and are working to meet the 2014 deadline to get exchanges up and running.

"You can crystal-ball yourself to death," said Peter Lee, the executive director for the exchange in California. "If the unthinkable became thinkable, there are members of the state legislature, there's an exchange board, there are constituents across the state who would say, 'OK, now's the time to take the next steps.' "

Lawmakers in California have floated the idea of introducing a statewide requirement for individuals to carry insurance or pay a fee. Massachusetts is currently the only state to have this requirement.
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Associated Press Rhode Island Democratic Lt. Gov. Elizabeth Roberts, above right, sees 'a role for an exchange here.'




Rhode Island officials, too, said they were pressing ahead with their state exchange and would also consider passing state-level legislation to substitute for parts of the federal law if they are struck down.

"There's a role for an exchange here…and that can happen no matter what happens with the Supreme Court," said Democratic Lt. Gov. Elizabeth Roberts, who has been overseeing Rhode Island's health-overhaul efforts.

Ms. Roberts said she had pushed legislation three years ago to create a state requirement to purchase insurance or pay a fine. She said she would be prepared to do it again, if necessary.
While states could still create their own exchanges if the whole law fell, they wouldn't get the law's federal funding to run them, or the federal subsidies designed to help lower earners buy coverage in the exchanges.

The executive director of the Colorado exchange, Patty Fontneau, said the legislation creating the state's exchange explicitly banned officials from using state funds to prop it up, and that funds from private companies or foundations might be options for keeping it going.

She said that as officials consider applications from vendors to provide the technology to run the exchange, they are discussing the importance of being able to adapt to a different landscape.
"The deadlines are so tight that we are continuing to move forward, because we have to be flexible, and we realize…we can't really stop and wait to see what happens in June," she said.

Most states have taken federal money to begin establishing their own exchanges, though they are at varying stages in the process. In all, the U.S. has given out around $730 million in set-up funds to date. A few states have turned away all funds.
Some Republican-led states, which have opposed the health-care law but have moved ahead with their exchange preparations just in case, said they would likely halt their efforts if the court overturns the law.

"We're prepared to stop at any time, or to consider moving forward," said Seema Verma, a health-policy consultant for Indiana GOP Gov. Mitch Daniels.

A spokesman for Florida GOP Gov. Rick Scott said the state would comply with the law if it is upheld, but that officials would "cross that bridge when we come to it." Florida has turned away federal money to create its exchange.

Lane Wright, the spokesman, said the governor's administration was "confident" the law "will be ruled unconstitutional, and so we're not very concerned how these exchanges would be set up."
 
Wow. The fact that most states have already taken federal money to implement an exchange seems like a potential pitfall if all or part of the law gets struck down. Will the states then be required to pay the money back?
 
I would bet that Congress just grandfathers the part that's already paid out, and move on from there. Or at least require states to pay back unused portions and grandfather the part that states used to research & plan for exchanges. Just my guess! We'll see...

I feel empathy for California brokers, but as a broker in your neighboring state of Arizona, I'm glad to see CA become an example. If/when the exchanges fail miserably, the likelihood of exchanges being implemented in other states is low, particularly in conservative states. Will exchanges fail miserably? My guess is they will fail if there are no subsidies to motivate people into the exchange. With subsidies, I predict that exchanges gain a reputation as the shopping hub for low-income buyers. Without subsidies, I predict it will fail to the same degree that the PCIP failed. Hey, but those are just predictions from one person's viewpoint.
 
When has failure (especially vs. cost) forced California to abandon something that isn't working? LOL
 
States give the money back?

Question: You're a contractor and are sure you have a buyer for the house. You pay over $20,000 in labor to your subcontractors, who have done the work. You now find out that your buyer's financing fell through. Can you force your subs to return your money?

Answer: Not a shot in hell.
 
Question: You're a contractor and are sure you have a buyer for the house. You pay over $20,000 in labor to your subcontractors, who have done the work. You now find out that your buyer's financing fell through. Can you force your subs to return your money?

There are two folks you won't want to be indebted to.

The mob and the government.

You tell the feds they can't have their money back.

FWIW, the state of GA has over $600 million in federal money the state took to cover unemployment comp benefits beyond the normal 26 weeks. The feds expanded benefits and when the states didn't have the money to fund the extension DC sent them money.

We are trying to figure out how to pay back Washington. My guess is they won't cut us any slack even though extending benefits was not our idea.
 
There are two folks you won't want to be indebted to.

The mob and the government.

You tell the feds they can't have their money back.

FWIW, the state of GA has over $600 million in federal money the state took to cover unemployment comp benefits beyond the normal 26 weeks. The feds expanded benefits and when the states didn't have the money to fund the extension DC sent them money.

We are trying to figure out how to pay back Washington. My guess is they won't cut us any slack even though extending benefits was not our idea.

Wow! Maybe I'm wrong in my assumption that they'll just grandfather the money that's already been used. I wonder what the govt will do to all those other subsides that have been paid out. There are a number of them, from subsides to medical office for digital records, to small businesses for healthcare premiums, to adoption credits for special needs children, breast feeding... Some of the dollar amounts are large and small businesses and families couldn't afford to pay it back since it's already been used for the original purpose intended. As Winter would say, "What a mess!".
 
California is one of the few states that have established a exchange board to address all issue the exchange faces.

Even with the subsidies the board is concerned with adverse selection and the exchange ending up as a high risk pool.

For a state that size the yearly admin could be $300 millions a year.

California is so carrier unfriendly they might have a hard time keeping an exchange competitive with the free market even with subsidies.
 
MASSACHUSETTS INSURANCE & EXCHANGE FACTS...
1. Only state with a Health Insurance Exchange
2. No Subsidies for anyone earning over $34,000 @ year.
3. Health Insurance is Mandatory
4. Penalty for Not Having Ins. is tiny compared to premiums.
4. Most expensive medical care in the nation.
5. Highest premiums in the nation.
6. Population Currently Insured: A Whopping 98.1% :nah:!
Source: Massachusetts health care reform - Wikipedia, the free encyclopedia


I don't get it. Why does Mass have such a high percentage of the population insured if there's virtually no subsidies provided to the middle-class and the premiums are sky high?

No wonder the Obama administration tried to pattern the basic foundation of the Affordable Care Act after Massachusetts. I bet the IRS will find every reason it can to disallow the subsidies for millions of Americans, knowing that the absence of subsidies in Mass. had virtually no adverse affect on enrollment.
-AC
 
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