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The feds will run Texas’ health insurance exchange

That seems to be where we’re headed.

Texas is almost alone among the nation’s largest states in failing to start work on a key piece of the Affordable Care Act, as legislators and state agencies follow Gov. Rick Perry’s wish to delay action until after a Supreme Court ruling and the November election.

“Politics superseded good policy,” state Rep. Garnet Coleman, D-Houston, said of the inaction on creating an exchange to help small businesses and individuals buy health insurance.
Texas is one of nine states identified by the Kaiser Family Foundation — other than Florida, the others are mostly small, with relatively few uninsured residents — as having made “no significant progress” toward establishing an exchange. A Perry spokeswoman said there are no plans to change that.

“(Perry) feels the health care bill is unconstitutional and misguided,” spokeswoman Lucy Nashed said. “There are no plans to implement an exchange.”

But analysts say the delay makes it more likely that the state will miss a Jan. 1, 2013, deadline for proving a state exchange is on track. If it’s not, the federal government will impose its own exchange.

State Rep. John Zerwas tried unsuccessfully to pass a bill last year that would have established an exchange in Texas, but it went nowhere as Perry expressed his opposition to it. If President Obama loses in November, or if SCOTUS throws out enough of the Affordable Care Act to cripple or kill it, then Perry will get his wish and will be able to continue blissfully ignoring the needs of the millions of Texans who lack health insurance. If not, he’ll have no one to blame but himself when the feds set up shop.

There is another possibility. The federal exchange is subject to the same Republican nihilism as anything else, and some states that are making progress towards establishing their own exchanges have experienced bumps in the road. It would not shock me if that January 1, 2013, deadline gets pushed back in the face of facts on the ground, thus giving the Texas Lege a second chance to get something going. Whether they get clearance to take advantage of such a scenario or not is another story.

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