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Will health insurance exchanges be on the Lege’s agenda?

The deadline was today for states to decide what they want to do about implementing health insurance exchanges.

It's constitutional - deal with it

At least eight Republican governors vowed not to implement the health-care law until after the November election. “I will make that decision number one after the election,” Alabama Gov. Robert Bentley told a local television station in September.

New Jersey Gov. Chris Christie said in late October, “I’ll make decisions when I have to.”

In the wake of President Obama’s reelection, and with the Affordable Care Act’s future secured, Republican-led states are scrambling to figure out what comes next for the law they squarely oppose.

“The folks who need to restrategize at this point are going to be the Republican governors, for the most part,” says Cheryl Smith, a director at Leavitt Partners, the health consulting firm founded by former Health and Human Services Secretary Michael Leavitt.

“They can’t just say no anymore. They have to accept that the Supreme Court ruling was what it was, and that the status quo is not sustainable.”

What, exactly, happens next is far from clear. States face a Nov. 16 deadline to inform Health and Human Services. That’s when they need to decide what they’ll do with their health exchange, a new insurance marketplace that each state will have in 2014.

I say it was today, because it’s now been postponed till January 1. Be that as it may, I don’t expect Rick Perry to accept anything that doesn’t fit into his worldview. It should be noted that there’s a decent argument for letting the feds do it.

Just for a minute, put yourself in the shoes of a Republican governor who has done very little to prepare for the health-care law. You think Obamacare’s the wrong direction for America and see public opinion data suggesting that half of the country agrees with you.

You waited out the Supreme Court decision, hoping they’d overturn the law, then the election, hoping the law would get repealed, and, all of a sudden, the law is here to stay and you barely have any time to implement it.

You could slap together a health insurance exchange at warp speed, hiring all the consultants you can find in the next few weeks. This decision is risky: If the health insurance exchange malfunctions (and it might, given the time constraints), the blame lands squarely at your feet. It’s also time- and energy-consuming.


Option two is leave the task to the federal government. They already promised that they’ll make sure every state has an insurance exchange standing by Jan. 1, 2014. They have a huge interest in making sure these exchanges work really, really well: This is, after all, the Obama administration’s signature legislative achievement.

We don’t quite know how well the federal exchange will work, but that’s almost irrelevant to a governor. If it functions really well, then the health law rolls out smoothly. Perhaps the state even takes control of the exchange within a year or two. If it bombs, the finger-pointing is directed toward the federal government — and not at the governor.

To an extent, Rick Perry and his crew are between a rock and a hard place, but I can’t honestly see them taking any proactive step to implement Obamacare even if the alternative is to invite the feds in to do it for them. Perry said he would not create an exchange after SCOTUS handed down its ruling, and he reaffirmed that stance yesterday. Still, I don’t think it matters. We’re too far behind on it already, and the Lege has plenty of other things on its plate. While I’m sure someone will file a bill to create an exchange, I’ll be very, very surprised if it even gets a committee hearing.

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