Election Aftermath: States scramble to set up insurance exchanges

[MovingTarget]

So now we have our answer...the PPaACA, aka Obamacare, will survive. The threat to "repeal and replace" it is dead. States now have ten days to set up their exchanges or defer to the federal government set up and run one for them.

NYTimes Article

The clock is ticking on the exchange question in particular: states have until next Friday to decide whether they will build their own exchange or let the federal government run one for them. Some states have asked the administration for more time.

So far, only about 15 states and the District of Columbia have created the framework for exchanges through legislation or executive orders; three others have committed to running exchanges in partnership with the federal government. A number of Republican governors, including those in Arizona, Idaho, New Jersey, Virginia and Tennessee, had said they would decide after the election, giving themselves only a 10-day window before the deadline.

I for one think that this was some very short-sighted thinking by many GOP governors and state legislators. They decided to "wait and see", and lost. If they had any sense, they would've had some sort of compromise backup plan for this scenario - a 2nd term for Obama. So, what happens now? Place your predictions here...

Edit: States merely have to declare their intentions, not set up the exchanges. Thanks to sactoking for pointing out that distinction.

 

[EagleKeeper]

I am sure that every one had a backup scenario.

The makeup of Congress was needed to tuneup.

 

[techs]

Not Florida. Rick Scott is going to ride his sinking ship all the way to the bottom.

 

[randomrogue]

I actually was surprised that all this wasn't a bigger election issue. The fact that our leaders chose to not be prepared should have led to them losing their jobs.

 

[Farang]

I actually was surprised that all this wasn't a bigger election issue. The fact that our leaders chose to not be prepared should have led to them losing their jobs.

You'd think it would be a statewide election issue for people like Perry and Scott who are refusing the Medicaid expansion in their state.

 

[sactoking]

The situation isn't as dire as portrayed for the simple fact that those in the media haven't a single collective clue about what is going on.

Technically, states have to have a Declaration Letter and Blueprint submitted by Friday the 16th. The Letter will declare the state's intent to set up a state-based exchange, a regional exchange, a partnership exchange, or do nothing. The Blueprint will be a technical implementation outline of how the proposed exchange will function.

Submitting a Declaration Letter buy the 16th is no problem: "Dear Secretary Sebelius, the State of ___________ elects ____________. Sincerely, Governor _____________".

The Blueprint is the tricky part, and that's the part that a state will be scrambling to finish in time. I mean, how do you decide upon and write a procedure for implementing a 2000 page law (as amended) in 5 business days? But here's the trick: you don't have to.

You see, since HHS/CCIIO is either completely incompetent or is willfully withholding information at the order of the administration, there are no regulatory rules detailing the specific requirements for programs that need to be outlined in the Blueprint. Additionally, many states will require their own enabling legislation and not every legislature meets year-round, or even every year.

The result is that states have been instructed that if they want something other than a federal exchange they must submit a blueprint but that blueprint need not contain anything more than a general outline of the proposed exchange. It will be possible, for all intents and purposes, to submit a Blueprint that says: "Sec. 8a- Navigators: Yeah we intend to have them. Sec. 12q- Risk Adjustment: Umm, we will handle the risk adjustment program".

Given that, no exchange should be "scrambling"; the Blueprint submission process has been defined by HHS/CCIIO to be a joke and states may treat it as such.

 

[MovingTarget]

The situation isn't as dire as portrayed for the simple fact that those in the media haven't a single collective clue about what is going on.

Technically, states have to have a Declaration Letter and Blueprint submitted by Friday the 16th. The Letter will declare the state's intent to set up a state-based exchange, a regional exchange, a partnership exchange, or do nothing. The Blueprint will be a technical implementation outline of how the proposed exchange will function.

Submitting a Declaration Letter buy the 16th is no problem: "Dear Secretary Sebelius, the State of ___________ elects ____________. Sincerely, Governor _____________".

The Blueprint is the tricky part, and that's the part that a state will be scrambling to finish in time. I mean, how do you decide upon and write a procedure for implementing a 2000 page law (as amended) in 5 business days? But here's the trick: you don't have to.

You see, since HHS/CCIIO is either completely incompetent or is willfully withholding information at the order of the administration, there are no regulatory rules detailing the specific requirements for programs that need to be outlined in the Blueprint. Additionally, many states will require their own enabling legislation and not every legislature meets year-round, or even every year.

The result is that states have been instructed that if they want something other than a federal exchange they must submit a blueprint but that blueprint need not contain anything more than a general outline of the proposed exchange. It will be possible, for all intents and purposes, to submit a Blueprint that says: "Sec. 8a- Navigators: Yeah we intend to have them. Sec. 12q- Risk Adjustment: Umm, we will handle the risk adjustment program".

Given that, no exchange should be "scrambling"; the Blueprint submission process has been defined by HHS/CCIIO to be a joke and states may treat it as such.

You are correct, and thank you for posting this. States merely have to declare their intentions, not actually set up the exchanges. It will still be interesting about what the GOP controlled states decide to do after all their huffing and puffing about the election.

 

[Hayabusa Rider]

This is going to be something to watch over the next few years. Prediction- You are going to see the law of unintended consequences kick in to an amazing degree. Those who wanted this will be blaming the Republican, the providers, the insurance companies, business, people, everyone who doesn't see the fine shining light at the end of the tunnel, which I believe will be the train coming down the tracks.

What an idiotic plan, but it's the best partisan hacks could manage.

 

[Throckmorton]

This is going to be something to watch over the next few years. Prediction- You are going to see the law of unintended consequences kick in to an amazing degree. Those who wanted this will be blaming the Republican, the providers, the insurance companies, business, people, everyone who doesn't see the fine shining light at the end of the tunnel, which I believe will be the train coming down the tracks.

What an idiotic plan, but it's the best partisan hacks could manage.

No, it's the best that could happen with Republicans and conservative Democrats obstructing every damn thing.

We told you we wanted Medicare for all. You said no. We said we wanted a public option. You said no. Now we're stuck with this exchange malarchy

 

[uclaLabrat]

It's still amazing to me that republicans use every opportunity to break government, then use it as an example of government not working.

 

[techs]

Actually people completely misunderstand.
For most people absolutely nothing will change.
For those who can or will get covered under the law they may have a difficult time at first, but, and pay attention, THEY WILL NOW BE GETTING HEALTH INSURANCE and its not like they are going to be marching on Washington or voting against the Democrats who helped them GET HEALTH INSURANCE.

Oh, and every Republican moron for a Governor who went out of his way to screw around, bad mouth the law, etc will be blamed for every miscue in its implementation. Fairly or not.

 

[Hayabusa Rider]

No, it's the best that could happen with Republicans and conservative Democrats obstructing every damn thing.

We told you we wanted Medicare for all. You said no. We said we wanted a public option. You said no. Now we're stuck with this exchange malarchy

What you said is that you have absolutely no understanding of the topic at hand. You didn't want reform, you really wanted change. They aren't the same. Precisely what needs of health care are met by "medicaid for all"? What use will it be to the practitioner trying to provide a service? List 5 things that health care needs that aren't insurance or coverage related and why they matter. By that I mean things that improve the provider/patient interaction and outcomes. It's like saying you want a public option at McDonalds where you can get a buffet and expect to find the food better. Clueless.

 

[sactoking]

Just got back to the office from our Economic Forum meeting to find that, contrary to earlier insistence, the blueprint deadline has been moved a month to December 14. Just another implicit acknowledgement that CCIIO has been a failure.

 

[MovingTarget]

Well, it looks like Alabama is not opting into the medicaid expansion and is refusing to set up its own exchange, according to the Governor.

Link

MONTGOMERY | Gov. Robert Bentley said today that Alabama will not expand Medicaid as it now exists and he won't set up a state insurance exchange under the federal health care law.

I can't say that I am surprised, but I am still disappointed. My state is already the epitome of a low-tax, low-service state. Our medicaid program has already been cut to the bone and has been at risk of losing the matching federal funding due to the lack of funding commitment to the program by the state.

But here's the kicker:

“I have been speaking individually and in group settings with governors from all over the country, and I feel that a significant number of these governors will take a similar stand,” Bentley said.

It looks like this will be an interesting time period in state legislatures across the nation. The GOP will likely remain as recalcitrant about the ACA as they were before the election, at least at the state levels.

 

[sactoking]

Any state that doesn't expand Medicaid is doing so for two reasons:
1) Cost- The federal pickup is only guaranteed through 2020. There is a legitimate expectation that in 2021 the "free" Medicaid expansion will revert to normal medicaid funding levels, which will saddle states with billions of dollars in additional Medicaid costs. Also, the "free" Medicaid expansion does not cover individuals who are currently eligible for Medicaid but for whatever reason choose to decline coverage, but who then elect coverage in 2014 when the mandate kicks in. The "currently eligibles" are slated to cost hundreds of millions of dollars regardless of what a state does with the expansion.
2) Political Pressure- By refusing to expand Medicaid, States create a "donut hole" below 100% FPL. Currently, States are free to determine Medicaid eligibility and most of them do not use blanket FPL as the requirement. Thus, someone might be at 85% FPL but ineligible for Medcaid, like an unmarried, childless adult under age 65. The ACA subsidy provisions explicitly kick in at 100% FPL, so if Medcaid expansion is neglected, those below 100% FPL and otherwise ineligible for Medicaid get stuck in the "donut hole" where they are ineligible for any low-cost coverage.

 

[DCal430]

You know what is funny about the medicaid expanse, California is under a federal court mandate to include undocumented immigrants in medicaid, but the federal government isn't mandated to pay for it. So the state has to pay for a significant portion of the expanse it self. California is the only state in the situation.

The same is true for food stamps and other federal programs too. California is mandated by the federal courts to pay for these things out of pocket for undocumented immigrants.