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No excuses for states on building insurance exchanges

From an editorial in Bloomberg View on Nov. 21:

Ever since health-care reform was passed in 2010, Bobby Jindal of Louisiana, Rick Perry of Texas, Scott Walker of Wisconsin and several other prominent Republican governors have vowed not to create the state insurance marketplaces, known as exchanges, the law requires.

Many of them say it’s impossible to comply with the law because the Department of Health and Human Services hasn’t given them enough information to move forward. Gov. Bob McDonnell of Virginia, writing on behalf of the Republican Governors Public Policy Committee, has sent President Barack Obama a list of 17 questions asking exactly what the exchanges will look like.

This strikes us as a bit of a smoke screen. Seventeen states and the District of Columbia are working on their online exchanges and six more have pledged to build joint state-federal exchanges.

The exchanges will basically take the form of websites, designed to lead people through the process of selecting an insurance plan, based on price and coverage. In the process, users will be able to determine whether they qualify for subsidies or for Medicaid. To design and plan such a website doesn’t require knowing, as McDonnell demands, for example, how the federal government will manage pools of high-risk patients.

It’s true that HHS delayed until last week issuing guidance on the benefits that insurance plans will be required to provide. It’s also true that the department was a little slow to come out with its rules on enrollment periods, rate increases, catastrophic-care plans and the ways in which premiums can vary. It’s eminently possible that these delays were attributable to politics (that is, a presidential election). Yet this information has arrived in plenty of time; the plain fact is that states didn’t need it in order to decide whether to go ahead with an exchange.

Perhaps prompted by this month’s election results, a few encouraging signs of softening have appeared. In Florida, Gov. Rick Scott, who began his political career by opposing the Affordable Care Act, is now saying, “Let’s have a conversation” about the law. Presumably, that means he will consider at least partnering with the federal government to create Florida’s insurance exchange. Still, 14 governors and one state legislature say they are sticking with their declaration not to play ball. A dozen more states have made no decision.

States have the information they need to move on insurance exchanges. Governors who care about fiscal responsibility, strong state government and the basic welfare of their residents would do well to get with the program.

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