The Evansville Courier Press has an editorial on Gov-elect Pence’s decision to defer implementation of health care exchanges to the federal government instead of exercising local control as the health care act permits.
The editorial drags out the old chestnut about Pelosi saying that we can’t know what’s in the health care act until we vote on it. Republicans seeking to score points on Obamacare have delighted in using that quote as ostensible proof that Pelosi was acting in a dictatorial or rash fashion – essentially forcing legislators to buy a pig in poke. But, the context of the quote was simply that, at the time, the particulars of the legislation was a moving target – as negotiations amended this or that; which – and this was the point of the quote – made it difficult to defend against false allegations about what was in there. (See, e.g. “death panels.”) It’s even harder to prove a negative about a document when the contents of that document are in flux.
But the Courier Press makes a good point – it’s time to stop using Obamacare for scoring political points. It’s the law now, and, like it or not, the best course of action now is to optimize its implementation. Make the best of a bad situation if you were opposed to it. The alternative is to make things worse for Hoosiers. However, the paper makes another good point – it’s hard to know whether federally run exchanges or locally run exchanges are ultimately better for Hoosiers.
It’s probably even tougher because many lawmakers and politicians have wasted the past few years trying to wish away Obamacare – time we could have spent preparing for implementation. (On a much larger scale, I expect we’ll see a similar dynamic when it comes to the impact of global warming – cursing the time we wasted pretending it wasn’t true.)
Doug,
State’s can still undermine the ACA’s promise of near universal coverage by failing to expand Medicaid as the law contemplated. This would leave many thousands, probably millions of people in these various states, just as they were. Poor, not categorically eligible, and with no benefits.
That being said, state hosptial associations may be able to lobby these recalcitrant states to expand Medicare and avoid inefficient and arbitrary cost-shifiting between payors, insureds, providers and the government.
As to whether Indiana or Uncle Sugar can operate an exchange more efficiently, I would usually bet on the fed against Indianapolis. But likely, after these Fed-run exchanges are up and running, they will be transitioned over to the state’s when the GOP tantrum is over.
Doug,
I just saw this on my home page. I have not been following this issue since the decision last summer. I do not know what is left hanging or to resolve in wake of the decision.
WASHINGTON (AP) — The Supreme Court has revived a Christian college’s challenge to President Barack Obama’s healthcare overhaul, with the acquiescence of the Obama administration.
The court on Monday ordered the federal appeals court in Richmond, Va., to consider the claim by Liberty University in Lynchburg, Va., that Obama’s health care law violates the school’s religious freedoms.
http://start.toshiba.com/news/read.php?rip_id=%3CDA2PNU4G1%40news.ap.org%3E&ps=1011
States do have some latitude, though. Should Colorado & Washington just forget about their laws just passed that thumb their nose at federal drug laws? Should the people there just suck it up? Get over their bad selves?
There’s a fine line between a tantrum and the will of the people. Not saying that Republicans aren’t trying to score points… except that you don’t score points by doing something entirely unpopular.
Mike,
If running a state-based exchange or defaulting to the Fed represents a policy choice that the electorate chose, I would like to see more evidence.
As far as Colorado and Washington and their MJ laws, it is the Fed’s choice whether to defer state-level prosecution. I think MJ should be legalized, but I suspect millions of America disagree, likely more so whether they care if the Fed runs the exchange or if their state runs the exchange.
Below is a link to a long article on the issues regarding new ACA litigation.
http://www.kaiserhealthnews.org/Stories/2012/November/29/health-law–litigation-and-exchanges.aspx
One of the most cogent analysis I heard of the ACA was about two years ago. I cannot remember the speaker’s name, but he said when we look back at the results of the ACA in 2020, we will see that many more individuals have health benefits that would not without the ACA. The cost of healthcare will continue to rise disproportinately releative to other Western democracies, but the US will have less uninsured, less unreimbursed care, and less cost-shifting.