Today, the Republican Governors Association Public Policy Committee sent a letter to President Obama regarding the deadline this Friday for states to declare their intention with respect to who will design and implement the new health insurance marketplaces, known as exchanges. The GOP governors ask for an extension until the administration “has answered the numerous previous questions for governors and other groups, and promulgated the final regulations” on exchanges.
As we noted in a blog post on Friday, Secretary Sebelius gave governors some additional flexibility last Friday. She didn’t lift the November 16 deadline for states to inform federal officials of their intentions, but she gave them an additional month to provide the blueprint for a state-run plan, and several more months to submit the blueprint for a state-federal partnership, if the state chooses to go that route. All that is required by this Friday is a decision on which of the three options a state chooses: a state designed and operated plan, a federal exchange plan, or a state-federal partnership.The point of the deadlines is that the federal Dept. of Health and Human Services (HHS) is required by the Affordable Care Act (ACA) to run exchanges in states that decide not to do it on their own, and those exchanges need to begin taking applications in October of next year. HHS needs to know soon where it will be responsible for designing and implementing exchanges, so it can begin the difficult and lengthy process of setting up exchanges that will operate effectively in those states.
Providing an extension of the Friday deadline would exacerbate the sizable challenge for HHS to design exchange plans for a number of different states, seek public input on each of those plans, incorporate that input, allow insurers to develop and price the products they will offer through the exchanges, and then actually get the exchanges up and running in each state so they can begin taking applications less than a year from now.
Even though exchanges are a fundamentally conservative, market-based approach to improving access to health care (backed by the Heritage Foundation and by Governor Romney in Massachusetts), some conservatives seem to be motivated by a desire to see the ACA fail, including the exchanges. We have maintained all year that regardless of whether governors and state legislators support the law, they should be making contingency plans to implement it, especially if they would rather have a state-run exchange than a federal exchange.
The fact that many lawmakers continued to resist implementation and didn’t make contingency plans, even after the Supreme Court ruling, makes it harder for those of us who support the ACA to be sympathetic to arguments that the governors need more time to choose between the three basic approaches to operating an exchange.
Jon Peacock
