Health Care Law: Exchange We Can Believe In?

Grace-Marie Turner is blowing the lid off the behind-the-scenes machinations as the Obama administration tries to get the states to set up health insurance exchanges, as required under the Patient Protection and Affordable Care Act (PPACA).

In National Review Online, Turner, who is president of the Galen Institute, a health care policy think tank, analyzes a report released last Friday by the National Governors Association. Entitled "Timelines, State Options, and Federal Regulations," the NGA report summarizes a two-day meeting of 120 state officials from 40 states and territories.

Challenges facing states implementing PPACA, Turner reports, include:

* Developing interconnected, automated systems to verify eligibility.

* Severely strained state budgets, including a lack of trained personnel to run the exchanges.

* Eligibility volatility. Income rules for insurance benefits mean that people will frequently move between Medicaid, a Basic Health Plan, and the Small Business Health Options Program (SHOP).

States that do not have exchanges operational by October 2013 will have a federally run exchange imposed upon them. States are concerned that if the federal government takes over access to state health care systems, the state will lose control over Medicaid, which is often a state’s largest single-budget item.

Turner sums up the NGA analysis in no uncertain terms:

This report shines one more spotlight on the massive and near-impossible task of implementing a law that attempts to overhaul one-sixth of our economy through a top-down, bureaucratic structure.

We'll be learning more about these state and federal insurance exchanges in the coming days -- and about market alternatives that are rising to compete with these exchanges for customers.

Source: "Health-Care Chaos," National Review Online, Sept. 19, 2011
Image by jondoeforty1, used under its Creative Commons license.

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Steve O'Keefe is a freelance writer and book editor who has worked for several libertarian publications and has edited such writers as Karl Hess, Erwin S. Strauss, and Kerry Wendell Thornley, among others.