Enactment of the Affordable Care Act (ACA) created a dilemma for Republican policy makers at the state level. States could maximize control over decision making and avoid federal intervention by establishing their own health insurance exchanges. Yet GOP leaders feared that creating exchanges would entrench a law they intensely opposed and undermine legal challenges to the ACA. Republicans\’ calculations were further complicated by uncertainty over the Supreme Court\’s ruling on the ACA\’s constitutionality and the outcome of the November 2012 elections. In the first year of operation, only seventeen states and the District of Columbia chose to design and implement their own exchanges; another seven chose to partner with the federal government, and twenty-six states ceded control to Washington. Out of thirty states with Republican governors in 2013, only four chose to launch their own exchange. Why did many Republican-led states that initially appeared open to establishing exchanges ultimately reverse course? Drawing on interviews with state policy makers and secondary data, we trace the evolution of Republican responses to the exchange dilemma during 2010–13. We explore how exchanges became controversial and explain why so few Republican-led states opted for their own exchange, focusing on the intensifying resistance to Obamacare amid a rightward shift in state politics, partisan polarization, and uncertainty over the ACA\’s fate.
The dilemma for Democrats: If additional states go California\’s way, more people who may have preferred their old plans will lose them, despite the president\’s promise, now withdrawn, that the health law would allow people to keep plans they liked.
Among states with Democratic governors, nine including California have said they won\’t allow carriers to renew the plans in 2014, seven have said they will and four were still deciding as of Thursday.
After the passage of the Patient Protection and Affordable Care Act in March 2010 and the affirmation of its constitutionality by the Supreme Court in 2012, key decisions about the implementation of health care reform are now in the hands of states. But our understanding of these decisions is hampered by simplistic sortings of state directions into two or three simple, rigid categories. This article takes a different approach — it tracks the variations in relative state progress in implementing Medicaid expansion across a continuum of activities and steps in the decision-making process. This new measure reveals wide variation not only among states that have adopted Medicaid expansion but also among those that have rejected it but have also made progress. We use this new measure to spotlight cross-pressured Republican states that have adopted Medicaid expansion or have prepared to move forward and to explore possible explanations for implementation that extend beyond a simple focus on party control.
Obamacare faces new threat at state level from corporate interest group Alec | World news | theguardian.comNovember 20, 2013
A new Alec proposal, approved by its annual meeting in Chicago in August and published as a model bill for adoption by state assemblies across the nation, would scupper the federal health insurance exchanges set up under Obamacare. The Health Care Freedom Act, as Alec calls its model bill, threatens to strip health insurers of their licenses to do new business on the federal exchanges should they accept any subsidies under the system.
Alec justifies the measure as a way to protect local employers from the “employer mandate” – the provision in Obama\’s act that penalises employers with more than 50 workers who do not offer any or sufficient healthcare cover for their employees. However, health insurance experts say that were the model bill to be taken up widely by Republican-held states, it would seriously disrupt the federal exchanges, and in turn put the whole health reforms in peril.
Legislation with almost identical language is already being debated in the state assemblies of Missouri and Ohio.
Many states have worked tirelessly over the past two years to develop health insurance exchanges and prepare for the expansion of their Medicaid programs in order to meet the requirements of the Patient Protection and Affordable Care Act. Programs to expand coverage, however, do not necessarily ensure seamlessness for many individuals who are likely to experience shifts in program eligibility due to changing circumstances (e.g., income fluctuations, family composition changes, etc.). A number of states are actively working to limit the impact of changes in program eligibility by developing policies that limit either the incidence of program eligibility changes and/or the impact those changes have on individual consumers. Various emerging state approaches take into account program history, the desire for state flexibility, and the political and operational challenges states face in developing coverage expansions that work for consumers, stakeholders, and policymakers.
State Efforts to Promote Continuity of Coverage and Care under the Affordable Care Act.
In sum, poorer Americans would get a guarantee of coverage and, with private but federally subsidized insurance, gain better access to quality care for significant expenses than they have now with Medicaid. Private insurance pays more and is accepted by many more doctors. But on the downside, the insured care would be less comprehensive than under current definitions of Obamacare’s mandate.
With a cheaper and more modest insurance package mandated under a retooled law, employers would be less intent on dropping coverage. That would help in job creation. It also would lower the federal cost of the subsidies through the exchanges, both because employers would cover more workers and because the insurance policies would be cheaper.
This wouldn’t be an ideal health care system, but it may be the best we can do, considering where we stand today.
The federal government is again open for business, and Republicans in Washington are licking their wounds from the failed Tea Party attempt to derail President Obama’s health care overhaul. But here in Virginia’s capital, conservative activists are pursuing a hardball campaign as they chart an alternative path to undoing “Obamacare” — through the states.
Report: If New Hampshire Expands Medicaid, State Hospitals Will Lose Hundreds Of Millions Of Dollars – ForbesAugust 28, 2013
In states that remain undecided about whether or not to expand Medicaid, as Obamacare prescribes, hospitals have lobbied furiously in expansion’s favor. That’s not surprising, on its face; hospital executives’ eyes widen at the possibility of hundreds of billions in additional taxpayer subsidies under the law. But an analysis from the Lewin Group, a prominent health care consulting firm, finds that if New Hampshire expands Medicaid, Granite State hospitals will actually lose $228 million in revenue over the next seven years. How is that possible? Read on.
As Detroit Goes Bankrupt, Michigans Senate Considers Adding Billions of Unfunded Liabilities to Its Medicaid Program – ForbesJuly 22, 2013
Last week, the City of Detroit filed for bankruptcy, making it the largest municipal bankruptcy in American history. It’s a remarkable story, especially for natives of the state, like me, who have watched Detroit slowly decline for decades. But it’s even more remarkable when you consider the fact that the Michigan state legislature is on the verge of adding billions in unfunded liabilities to the state’s Medicaid program, precisely at the time when Michigan’s politicians should be most acutely aware of the dangers of fiscal irresponsibility.