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November 19, 2012 at 09:08 AM
A Republican governor in New Mexico is moving ahead with efforts to start a Patient Protection and Affordable Care Act (PPACA) health insurance exchange for her state.
Some other Republican governors have refused to start developing PPACA exchanges for their states.
Some readers of LifeHealthPro.com and a few members of Congress really are fervent free-market libertarians who don’t think the federal government should have any involvement in ordinary health care finance.
Most of the Republican governors involved in the PPACA health exchange story seem to have accepted the idea that at least some federal government involvement in health care is a necessary evil. It doesn’t seem as if any of them has tried to send all of their states’ Medicaid funding back to Washington.
So, to me, it looks as if this is a conflict involving different types of government interventionists.
The main argument of some of the governors who are sitting out is, basically, that the PPACA drafters were a bunch of Commie bozos.
Some other, more temperate PPACA opponents, such as South Carolina Gov. Nikki Haley, are saying that they are sitting out because, even though the U.S. Department of Health and Human Services (HHS) has talked about offering states as much flexibility as possible, HHS hasn’t really allowed states enough flexibility to run the exchanges how they’d like to run the exchanges.
To me, it seems as if the following principles shape the PPACA exchange stand-ff:
- Most Republicans could actually live with the idea of insurers selling insurance through some kind of exchange. The governors who led efforts to set up the two existing state exchanges, in Utah and Massachusetts, were Republican governors.
- The PPACA exchange rules, such as the rules governing new PPACA risk-management programs, are really complicated, may conflict with each other, and, in some cases may well contain glitches that would horrify any health care actuary or other risk-management expert, whether that expert was a Democrat, a Republican or a loyal LaRouche supporter. Chances are that no one in Congress is madly in love with the PPACA risk-management programs.
- Republicans have had a history of preventing the Democrats from fixing PPACA, even when Democrats might have been willing to fix it, by focusing mainly on bills designed to kill off PPACA as a whole, or major chunks of PPACA, in ways that would be as humiliating as possible even for a Democrat who liked PPACA. The overriding goal seemed to be to make sure that PPACA would be as horrible as possible, to maximize voter hatred of the Democrats, rather than to maximize the well-being of the country. The one time the Republicans relented and proposed a PPACA fix bill that a Democrat could vote for — the 1099 fix bill — President Obama ended up signing the bill into law.
A modest proposal: Maybe the Republicans could demonstrate that they are serious about trying to be part of the solution, rather than part of the gridlock problem, by developing a PPACA fix bill that has strong appeal for health insurers, health insurance agents and the senators commonly identified as being moderate Democrats.
