Must pick method to implement next step of Obamacare
Cliff Peale and Barry M. Horstman reports:
Ohio is trying to retain some control of a health care exchange mandated by the Affordable Care Act, even as it probably will default operations to the federal government.
Even with a federal-run exchange, state control could include certifying health plans that participate and determining Medicaid eligibility.
Meant to provide affordable policies to those without insurance, the exchanges are a key part of President Barack Obama’s health care reform law. They are one of the latest flashpoints in implementing the law.
States have until Friday to declare if they will operate their own health care exchange. They also can default to a federally run exchange or choose a hybrid model, with deadlines later in those cases.
Gov. John Kasich, a Republican, hasn’t announced a decision, but it appears unlikely that Ohio will operate the exchange itself.
Kentucky, with a Democratic governor, has moved aggressively toward its own state exchange, using about $66 million in federal grants to create and implement the marketplace. Indiana, with Republican leadership, is expected to default to the feds.
With Obama’s re-election Nov. 6, the law colloquially known as “Obamacare” will remain in place, but setting up the exchanges is among dozens of steps before it is fully implemented in 2014.
“We now know what the playing field is,” said Robyn Chatman, a primary care doctor and president of the Academy of Medicine of Cincinnati. “For those who don’t like it, at least they know what to expect.”
Decisions on how to implement the ACA will impact millions of Ohioans.
Starting in January 2014, the law requires consumers to buy insurance or pay a penalty, employers with more than 50 workers to offer benefits or pay a penalty, and insurers to accept anyone who applies.
Dozens of uncertainties remain.
For example, Ohio and many other states haven’t decided whether to accept a Medicaid expansion that could bring $17 billion in federal money during the next six years, but also would force the state to pay for those currently eligible who aren’t already receiving benefits.
Pluses, minuses to state exchange
The exchange issue is critical because at least 7 percent of companies, mostly smaller ones, are expected to stop offering benefits and force employees to buy insurance on health care exchanges.
Benefits of a federal exchange start with cost. A study commissioned by Ohio officials showed that annual operating costs of a state exchange would range from $19 million to $34 million, excluding technology. Fees from providers and insurers would pay most of those costs.
But the state exchange also holds benefits, most prominently the ability to manage the insurance marketplace while it also regulates doctors and hospitals.
For example, while any plan would have to meet federal standards for minimum benefits, the state could monitor compliance with enrollment periods, premium increases and consumer complaints in a state-based exchange.
“The positive (of federal control) is, it takes that monkey off the state’s back if the exchange can’t sustain itself,” said Kate Keller, senior program officer at the policy Group Health Foundation of Greater Cincinnati. “The negative is, you have someone else outside of Ohio making decisions.”
The distinction won’t matter much to consumers “until you have a problem,” Keller added. “It becomes a much bigger bureaucracy” under federal control.
For Kasich, a former U.S. House budget committee chairman who faces re-election in two years and could harbor national political ambitions, the decision on the exchanges presents an interesting political choice: Assume the financial risk of the state exchange or allow the federal government to take over health care for hundreds of thousands of Ohioans.
Gene Beaupre, a political science instructor at Xavier University, said Kasich’s track record during his nearly two years in office suggests that he might be relatively unmoved by the political fallout attendant to his decision, being guided more by its policy implications: “The stakes are high, because while some people will be willing to live with whatever decision is made, for a significant number of people it’s going to be a litmus test. Kasich has to somehow make this work for Ohio. He has this refreshingly cavalier approach of, ‘I’m going to do what I think is right and let the chips fall where they may.’ We may see that here.”
Maurice Thompson, executive director of the Columbus-based 1851 Center for Constitutional Law, said Kasich’s and Ohio’s opposition to a state exchange conceivably could – if enough states follow the same course – force Obama administration officials to review and perhaps alter the program.
“The less cooperation and more resistance there is, the more likely it is that this will be reopened and amended, which at a minimum is what we hope to see,” Thompson said.
Two-thirds of Ohioans oppose Obamacare, Thompson said, a claim based on statewide voters’ 2-to-1 approval of a 2011 ballot measure billed as a “Health Care Freedom” initiative. That is significantly higher than the 50.2 percent of Ohio voters who backed the president’s re-election last week, he added.
“That’s a reason to resist rather than embrace the law … from both a political and policy standpoint,” Thompson said.
An Ohio Newspaper Organization/Enquirer poll in September, though, found that 48 percent of Ohioans supported keeping the law or expanding it, while 44 percent favored some form of repeal. Eight percent didn’t have an opinion.