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The deadline for states to commit to creating their own health insurance exchanges under Obamacare was Friday, with half the states ultimately refusing to do so, leaving the federal government with that job. That includes some of the country's most populous states.

New Jersey, Ohio and Florida, several of the biggest states that had not declared their intentions, officially said no late in the week.

"I have determined that federal operation of the Exchange is the responsible choice for our state," New Jersey Gov. Chris Christie, a Republican, wrote in letter Friday to Kathleen Sebelius, secretary of the Department of Health and Human Services.

For consumers, it should make little difference whether the new Internet sites are run from state capitals or Washington, D.C. But federal regulators hoped states would shoulder some of the work and stakeholder groups such as hospitals and insurers wanted states to help as well. The exchanges will open for business Oct. 1. [...]

Twenty-five states, most Republican-led, have said they will let the federal government run the marketplaces, also known as exchanges. And seven governors from Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and South Dakota have sought approval for the third option—a partnership with the federal government.  Three of those—Arkansas, Delaware and Illinois—have already received conditional approval. A report by the Charleston, W. Va., Gazette said West Virginia also decided late Friday to opt for a partnership with the federal government.

Setting up a system for 25 states puts a strain on the federal government that wasn't really planned for in the development of the law. It means a massive ramp-up to Oct. 1, one that has to deal with all the varying existing state regulations and create a mega-exchange. More significantly, it's a massive technological challenge. Because it will essentially be a huge database behind the online interface the public will use, all of the disparate state database systems will have to be reconciled. It's all about who's eligible and at what subsidy level, including Medicaid eligibility. So the large exchange will have to merge tax files, immigration status, Medicaid rolls, and more from the varying states. By not participating, these mostly Republican governors are attempting to throw the ultimate monkey wrench into the mix, still hoping to kill the law.

On the other hand, there tremendous opportunity, if the feds can make this work by Oct. 1. A robust, national health insurance marketplace could ultimately be cheaper and more efficient. It could be the model that shows a national health care system works, taking us one step closer to a public national health care system.

Originally posted to Joan McCarter on Mon Feb 18, 2013 at 08:28 AM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Yep Even w 25 Different Reg Sets, if It's 1 Buying (28+ / 0-)

    pool, that's some serious price negotiation power. For that aspect of it the biggest possible pool is the best.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Mon Feb 18, 2013 at 08:31:44 AM PST

  •  I can't figure out why (4+ / 0-)

    state governments would even want to bother with the hassle of setting up exchanges.  Or even why exchanges are even a good idea.  It's yet another time and efficiency wasting administrative mess.

    The banks have a stranglehold on the political process. Mike Whitney

    by dfarrah on Mon Feb 18, 2013 at 08:38:15 AM PST

    •  As someone who just had surgery recently (25+ / 0-)

      trust me on one thing: there is no bigger time-wasting example of inefficient administration than a private insurance company. I had to photocopy my insurance card and fax it to the insurance company before they would even admit I had their plan.

      "I am not just a strange dude; I am a SUPER strange dude!" - Super Grover 2.0

      by DeathDlr73 on Mon Feb 18, 2013 at 08:45:38 AM PST

      [ Parent ]

      •  Exchanges do nothing to alleviate the problem (11+ / 0-)

        of private insurance companies.

        •  That's what I just (4+ / 0-)
          Recommended by:
          Sparhawk, enhydra lutris, chuckvw, cdreid

          don't get.

          What exactly are the exchanges supposed to do?  Is it some sort of one-stop shopping for all available policies?  Even then, what would be the advantage when you can just look up poilicies on websites anyway?

          The banks have a stranglehold on the political process. Mike Whitney

          by dfarrah on Mon Feb 18, 2013 at 09:09:58 AM PST

          [ Parent ]

          •  Yes, one stop shopping. (27+ / 0-)

            Plus it figures out whether you are eligible for (expanded) Medicaid.

            Plus it administers your getting the Federal subsidy, if appropriate.  IIUC.

            I think one-stop shopping is a big win.  I think you underestimate the hassles and problems with going to different websites of different companies and having things laid out in different formats.  In theory everything will be presented in a much more uniform and explicable fashion on the exchange website.

          •  You guys are showing your ignorance on the subject (44+ / 0-)

            While an exchange is not single payer and still keeps the private insurance market alive, to claim it does nothing is completely wrong:

            1)You have purchasing power due to the pool size and the ability to negotiate prices, with the latter being optional but many blue states going ahead with it

            2)The insurance plans that are allowed to sell on the exchange need certain criteria like necessary and minimum benefit packages, free preventative care etc...

            3)They will be regulated: i.e. No annual and lifetime caps, no bans or recessions, 80-85% MDL, community rating, no premium hikes on individuals as opposed to groups, no gender rating. All those things are banned. For those of us who are familiar with the individual market and those terms, this is ridiculously huge.

            4)With the regulations, there are only 3-4 facts about each plan that you need in order to compare price, but until now insurance companies have hid that info in confusing and long paperwork. Now each exchange will have each plan displayed with only the 2-3 items that are relevant, i.e premium, coverage etc... This makes price shopping, impossible before this, pretty easy.

            5) Lastly, and key to the whole thing, everyone will get subsides on a sliding scale for everyone from 100% to 400% poverty levels. I don't think people understand that for people at the 150-200% poverty level, a huge portion of the uninsured, the subsidies are huge and a huge chunk of your premium will be absorbed.

            •  I am ignorant on HCA. (0+ / 0-)

              [1] So, as an individual, I will be able to negotiate a price?  I won't be in a pool.

              [3] Are insurance companies really going to participate with all of these coverage requirements?  

              [5] I don't see what subsidies have to do with the administrative side of establishing an exchange.  

              The banks have a stranglehold on the political process. Mike Whitney

              by dfarrah on Mon Feb 18, 2013 at 09:41:05 AM PST

              [ Parent ]

              •  Sure, let me help (28+ / 0-)

                1)You will be in a pool in the exchange and the plans being sold there are the same for everyone. There will be 3 levels, Bronze, Silver, and Platinum. The exchange has "Community Rating", meaning you are not charged and rated as an individual and your health status is irrelevant. Because all exclusions like pre-existing conditions and gender rating for women have been banned, you're not really important.

                There is sort of a price and pre-clearance for insurance companies to sell in the exchange, so premiums are already set and they will be displayed for you and everyone to see without any of your health info needed. There are some variations for people who are still smokers, and for age, but thats been limited. So the overall experience with an insurance company is totally different, the exchange is the middle man and the insurance company doesn't see you as an individual.

                2)Insurance companies have no choice but to participate. Thats the new world they live in, the only place where you can sell plans to individuals and small businesses is in the exchange. Normally requirements this stringent would force insurance companies to simply leave the state, but these regulations and requirements  are nationwide. They have no choice on this issue.

                3)The subsidies are run through the exchange, you put your income level in there, and it tells your subsidy and the amount you will end up paying in premium after that. The subsidy doesn't go to  you, it goes directly to the insurance company and shows up in lower premiums. This is great for consumers because they have no up front cost with a rebate later.

                Now, the system isn't perfect. I would prefer a single-payer system to get rid of the clutter and contain health care costs. Now, if thats not doable, there is a framework with an individual mandate and private insurance used in Switzerland and Israel that are among the best healthcare systems in the world. The kicker is they have price controls on top of everything else. So,uUltimately, we either need a single payer system or the ACA will need to be amended to have price controls.

                •  Regarding premiums (8+ / 0-)

                  Once in the exchange, insurance companies can still raise premiums, which I don't like, but they have to do it on the whole group cause everyone's treated the same.

                  They have historically been much more wary of big group hikes cause it could cost them tons of business. Thats not a perfect system though, and still not enough of a clampdown for me.

                •  I think it's bronze, silver, gold and platinum.... (4+ / 0-)
                  Recommended by:
                  rabel, deepeco, musiccitymollie, tb mare

                  There will be a basic level of required coverage, and we'll be able to select our level of risk tolerance vs. out of pocket expenses.   If you have it, a lot of money will buy lots of extra benefits with low out-of-pocket charges (platinum).   For employees, 8% of your paycheck will cover most families' annual needs, not without some co-payments, but this will be universally availble through most employers (silver).  You'll be able to pay a little more in premium for lower annual out-of-pocket, but if you don't use it you'll lose it (gold).     Most of us will be on the hook for some hefty co-payments, especially for things that we can control  (smokers will pay more).    The safety-net plans may stop covering "quality of life" services  (think: scooters for fat diabetics) (bronze).  

                  Most working people who get their insurance through their employer won't see much change at all, at first........ then they'll notice that they can shop between two or three national companies for the same exact product.   If one company keeps screwing their subscribers, people will switch to another company next year.   Everybody will understand exactly what their policy is supposed to cover.   Everybody will understand if the insurance company tries to deny services they should be covering.  
                     

                  •   (0+ / 0-)

                    Right now we get insurance through my wife's job at a state university.  It's a pretty good policy.  Is it safe to assume that if she takes early retirement and we go individual for a few years until Medicare kicks in our premium through the exchanges will be about the same as what employer & employee are paying now? (ie similiar to getting COBRA coverage).  Because that's still a lot of money ($20K/year).  And if they can charge older folks more, what sort of bill are we looking at?

                    •  Why would you leave your wife's plan?! (0+ / 0-)

                      Most state employees can carry their health insurance plan into retirement -- and it's much cheaper than going to an individual plan.

                      I'm a retired civil servant, and I'm on the same plan I was on when I was working. When Open Season comes around, if I find a plan that better fits my needs, I'll switch to that one.

                      When I'm eligible for Medicare, my current health insurance will become my supplemental plan.

                •  Question on subsidies (2+ / 0-)
                  Recommended by:
                  deepeco, musiccitymollie

                  If I remember correctly, if you are older but pre-Medicare, you can be charged up to 3x what a young person will be charged. Do you know if subsidies are a flat amount or a percentage of the premium? Do the subsidies take into account the premium cost? Assuming both persons are single, consider the following hypothetical case:

                  Person Y(oung) opts for a $200/mo plan and qualifies for $100/mo subsidy and ends up paying $100/mo for insurance.
                  Person O(lder) has the same income and opts for same package, but it costs $600/mo. If the subsidy is a flat amount, O can still be on the hook for $500/mo, or effectively 5x rather than 3x the cost of the plan for Y. It is also likely that O will have higher out-of-pocket costs, and will that be taken in consideration for the amount of the subsidy?

                  I'm safely on Medicare, but I have friends who won't qualify for several years and still might not be able to afford one of the exchange plans. As much as they want insurance, they might decide to pay the penalty instead.

                  •  Subsides are income based (1+ / 0-)
                    Recommended by:
                    tb mare

                    The subsidies are income based and scaled.
                    In general, if a Silver level policy costs less than 10% of your income, you have to get insurance or pay a penalty.
                    If your income is between 133% to 400% of the Federal Poverty Level, then you only have to pay between 2% and 9.5% of your income for the same plan and the Federal Government covers the rest.
                    If you don't want to buy insurance, you don't have to because you still don't meet that 10% income requirement.

                    KFF has all the info you could ever want on health care reform. http://www.kff.org/...

                    •  That clarifies it (0+ / 0-)

                      Many thanks. I hadn't realized the system is one where you pay up to your max % of income and the feds pick up the rest, no matter how much it is. So no matter what one's age, if your income is $9K pa, for example, you pay your % share, and the feds cover the remainder, with greater dollar subsidies going on behalf of older folks because their premiums are more.
                      This makes me wonder if this will lead to the federal gov't paying more to subsidize a 60 year old's health insurance than a 65 year old on Medicare. Perhaps after a couple of years, there will be a realization that we should lower the age for Medicare eligibility instead of trying to raise it.

                •  very lucid explanation. thanks. (2+ / 0-)
                  Recommended by:
                  alkatt, tb mare

                  To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

                  by kareylou on Mon Feb 18, 2013 at 08:36:45 PM PST

                  [ Parent ]

                •  Thank you (0+ / 0-)

                  That's very helpful information, really well-explained.  All my research just gives me confusing double-talk as to what it all means.

                  The scene on November 6, midnight: Barack Obama holds up newspaper reading "Romney defeats Obama" as he heads to give his second term acceptance speech.

                  by alkatt on Mon Feb 18, 2013 at 11:13:30 PM PST

                  [ Parent ]

            •  enormously speculative as to points 1 &4, it (0+ / 0-)

              isn't at all a given that your vision is accurate.

              That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

              by enhydra lutris on Mon Feb 18, 2013 at 12:55:50 PM PST

              [ Parent ]

            •  They're the same as a national exchange (1+ / 0-)
              Recommended by:
              RJDixon74135

              But a national exchange has greater bargaining power and can accomplish the task more efficiently.

              State exchanges in addition to the national exchange just create a confusing patchwork that may end up providing consumer with less choice and higher costs.

              Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

              by Betty Pinson on Mon Feb 18, 2013 at 06:53:01 PM PST

              [ Parent ]

              •  Given half the country has signed up (0+ / 0-)

                for the national exchange, it's much less of a patchwork than we thought it would be.

                And California is big enough that having its own exchange makes sense.

                •  We'll see (1+ / 0-)
                  Recommended by:
                  peregrine kate

                  Consumers will need to do their homework before moving from a state coupled to the federal exchange to one that is state managed.  

                  Given the state exchanges are much more expensive to set up, and given the cost of doing so isn't in the ACA budget, it could end up costing consumers much more in those states.

                  Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

                  by Betty Pinson on Mon Feb 18, 2013 at 07:19:55 PM PST

                  [ Parent ]

                  •  The State exchanges already exist (0+ / 0-)

                    Like the Feds, the States have public employees. Those employees pick their insurance plans from a State health benefits plan just like the Federal employees do with FEHB.

                    When you hear or see ads reminding people that it's "open season" that means that public employees are choosing their insurance plan for the following year.

            •  Thanks for this, ai, (0+ / 0-)

              and thanks to Ky. Gov. Steven Beshear.  he is literally  surrounded by ACA-hating governors, but he did the right thing for his people.

            •  I'm middle class (0+ / 0-)

              at least usually. I will be paying $4000+ a year according to the website. I dont have or want insurance now and see no need to pay 4k a year so people can scam oxycotin/valium scrips free btw. The real point is that people need to stop overpromoting the subsidy thing especially considering that most people dont have a clue as to the actual subsidy.

              A man is born as many men but dies as a single one.--Martin Heidegger

              by cdreid on Tue Feb 19, 2013 at 07:54:00 AM PST

              [ Parent ]

          •  It's more insurance reform than HC reform (2+ / 0-)
            Recommended by:
            rabel, YucatanMan

            But it's better than what we got now.

            "Michael Moore, who was filming a movie about corporate welfare called 'Capitalism: A Love Story,' sought and received incentives."

            by Bush Bites on Mon Feb 18, 2013 at 07:17:07 PM PST

            [ Parent ]

    •  When asking if exchanges are even necessary (18+ / 0-)

      you shouldn't make the mistake that many progressives make, which is to naturally assume that Plan B to the exchange is some some universal national system. That system doesn't exist, its a theoretical solution on paper, so its irrelevant to measuring the necessity of an exchange. It's like republicans being against trap laws and other restrictions against abortion because what really should happen is the Roe v Wade being overturned.

      Its totally understandable to argue there are better solutions, in the abstract, and that the ACA could've been better when we had the chance, an argument I make all the time. But when measuring whether to have an exchange today, you have to measure it against what is left if its not there.

      So, for the foreseeable future, its exchanges or the current system, a system where it's just you and the insurance company, where you can be dropped at anytime, denied at anytime, charged any premium, have annual and lifetime benefits capped, and have to absorb all the cost yourself, with zero help from the government.  THAT is what you compare the exchanges and their various protections to.

    •  My state, MN, really wants to do it right BUT (1+ / 0-)
      Recommended by:
      Involuntary Exile

      It is going to be very expensive to do it right and it's a good thing we have both houses of the legislature and the governor all Democrats or there would never be enough funding to do it right.

      This is another example of the federal government not adequately funding their legislation.

      They pass a law that requires excellent IT infrastructure to deploy a consumer friendly web site in a way that informs without confusing and they just shrug it off.  

      •  Future conservative governors (3+ / 0-)

        and legislators can also make changes to state exchanges that make them unaffordable for consumers.  That will be much more difficult to do at the federal level.

        I was very, very relieved when Kasich opted out of the state exchange for Ohio.  We're much better off letting the federal government handle that task.

        Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

        by Betty Pinson on Mon Feb 18, 2013 at 06:56:22 PM PST

        [ Parent ]

        •  I was similarly relieved (1+ / 0-)
          Recommended by:
          RJDixon74135

          when I saw that Virginia had opted out. No way do I want to buy health insurance from a system designed by Ken Cuccinelli.

          To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

          by kareylou on Mon Feb 18, 2013 at 08:40:45 PM PST

          [ Parent ]

    •  They're not necessary, nor helpful (1+ / 0-)
      Recommended by:
      cdreid

      It was a last minute idea added to ACA under the guise of "getting more votes".  It was never part of the original plans and studies that went into designing ACA. It didn't work.  

      It was a convenient way to spread around a lot of federal money at the state level to "study stuff" - allowing governors and state level politicos to get their friends, family, etc. appointed to boards and commissions.  Once the money was spent, states lost interest.

      Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

      by Betty Pinson on Mon Feb 18, 2013 at 10:55:44 AM PST

      [ Parent ]

    •  Anyone who's ever purchased individual... (12+ / 0-)

      health insurance will immediately understand the usefulness of an exchange.

      The ability to make an apples-to-apples comparison between plans on a single website will create a significantly more competitive market.

      As it stands now, you have to use your insurance commissioner's website to figure out who offers individual plans then check each company's site and navigate your way toward that company's benefit descriptions. Those descriptions are in no way uniform. Comparing them requires creating your own spreadsheet, which will undoubtedly be full of blank spaces. And that's without even touching on exclusions.

      "The Democratic Party is not our friend: it is the only party we can negotiate with."

      by 2020adam on Mon Feb 18, 2013 at 03:47:46 PM PST

      [ Parent ]

    •  Maybe THIS is why you can't figure (1+ / 0-)
      Recommended by:
      Lovepolitics2008
      I am ignorant on HCA
      That might be a good place to start before proclaiming:
      It's yet another time and efficiency wasting administrative mess.
      You should try thinking before typing.
  •  Here's the million dollar question though (12+ / 0-)

    Is the Federal government going to have 1 Federal exchange for the 25 states, or do 25 exchanges for the rolls of each state, but simply use a generic interface. If its the former, then I'm completely fine with this and think its great.

    Remember, the plan in November/December of 2009 was to have 1 national exchange, like the House plan, due to the size of the pool and purchasing power. Before Scott Brown, when they were planning the conference committee, it was widely reported that the PO would go, but the WH was saying they preferred 1 national marketplace like the House plan and there was a consensus building around that.

    There reasoning then was, while the work was going to be more tedious since all non-government, under-65 healthcare is administered at the state level, the end result would've been better due to pool size and purchasing power. Ofcourse, that all blew up after Scott Brown won since we then had no choice but to use the Senate framework.

    •  The "Federal Exchange" already exists (12+ / 0-)

      Just go the OPM website, opm.gov

      Look at the Federal Employees Health Benefits program. Before I retired from HHS last year, we were told that FEHB was going to be the Federal health insurance exchange.

      It runs in all 50 states (since all of them have Federal employees), the contracts and prices have already been negotiated by OPM, and most of the plans have some vision and dental benefits.

      It is subsidized insurance, the employee pays part and the government picks up the rest.

      •  Yes, its already in place (2+ / 0-)
        Recommended by:
        kareylou, RJDixon74135

        and will work efficiently for the other 25 states who chose to go with the federal one.

        As for the other 25 states who are going to spend a lot of tax dollars in a DIY effort, the result won't be better and could be much worse.

        Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

        by Betty Pinson on Mon Feb 18, 2013 at 06:58:16 PM PST

        [ Parent ]

        •  Nope -- those states have public emloyees too (0+ / 0-)

          To the best of my knowledge, these states have civil servants and also have a multi-choice health insurance benefit plans available to those employees.

          If you see or hear ads for an "open season" in your area that means the state employees are selecting their health insurer for the following year.

          It's the path of least resistance -- all the heavy lifting was done years ago when these benefit plans were set up.

          This nonsense about not having enough time to set up exchanges, is just that, nonsense.

      •  Well then, problem solved! n/t (0+ / 0-)
  •  Sounds like a great reason to start (11+ / 0-)

    putting folks back to work, handling the exchange. Come on Obama...this could be a great stimulus for job production.

    I have decided to stick with love. Hate is too great a burden to bear. Martin Luther King, Jr.

    by cyeko on Mon Feb 18, 2013 at 09:01:10 AM PST

    •  Yes, just think of it. (1+ / 0-)
      Recommended by:
      DocGonzo

      Instead of wires we could have... tubes.  And millions of people pushing paper through... tubes. Intertubes.

      To be serious, it's a good job opportunity for a bunch of programmers and managers and software testers, but hardly a great stimulus for the economy.

    •  I'm in complete agreement with you. (6+ / 0-)

      I was thinking this exact thought.  What also occurred to me is the fact the rethugs want to shrink government, yet they defer to the government to make this happen, thus enlarging a government department.  Hilarious!

      I think it is great for the feds to do this much work because I believe, in the end, it sets the groundwork to incorporate all other 25 states into one large plan, which it should be to begin with.

      being mindful and keepin' it real

      by Raggedy Ann on Mon Feb 18, 2013 at 09:13:11 AM PST

      [ Parent ]

    •  Even better - actually provide coverage (2+ / 0-)
      Recommended by:
      kareylou, cyeko

      for those who are still uninsured.  

      There will be tremendous job expansion in the health care field as a result of all Americans having access to affordable health care.

      The sooner we get people covered, the sooner the jobs will be created.

      Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

      by Betty Pinson on Mon Feb 18, 2013 at 07:00:01 PM PST

      [ Parent ]

  •  Indiana is being a stubborn ass because we want (4+ / 0-)

    The expansion of Medicaid and the handling of the exchange to go through our Healthy Hoosier program.

    We of course want that, because then it would be subject to block grant rules which allow Indiana state legislature to siphon money of towards other things not at all health related.

    Or at least related to direct primary care.

    Here's Pence quoted recently

    "To do so, in my view, would be to expand a highly flawed program in Indiana and place an enormous burden on Hoosier taxpayers,"

    Yes you moron, because a program funded at 100% for the first few years is a TERRIBLE burden on taxpayers of your state.

    Idiot.

    --Enlighten the people, generally, and tyranny and oppressions of body and mind will vanish like spirits at the dawn of day. - Thomas Jefferson--

    by idbecrazyif on Mon Feb 18, 2013 at 09:08:06 AM PST

  •  This sounds potential for a total clusterfuck. (8+ / 0-)

    Anyone who thinks all this is going to come together by October 1 (or even possibly the next October 1) if they have to start now for 25 states, without massive problems or even a total failure, doesn't understand software.

    Cf. The Mythical Man Month.

  •  It was inevitable (4+ / 0-)

    I never understood why Reid & the WH amended ACA in the Senate to push all this stuff to the state level.   It wasn't necessary for passage and, like so many of the other state control provisions, just made health care reform a messy, expensive patchwork that only hurts consumers.

    At the time, the assumption of HCR activists was that "savvy business lobbyists" convinced a few Dems in the WH and Senate that it would help pick up GOP votes.  LOL! The decision was political, not based on good public policy.

    Actually, those industry lobbyists thought having states in charge of these processes would make it easier for them to control and rig the regulatory process.   Turns out, many states just didn't want the hassle and expense of trying to manage it.

    Yeah, pushing responsibility for HCR out to the states was a bad idea from the start.  We knew it, they knew it, now everyone knows it.

    Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

    by Betty Pinson on Mon Feb 18, 2013 at 09:15:50 AM PST

    •  Betty...they had no choice (8+ / 0-)

      The House plan had a national exchange with a PO and the Senate plan had neither. So in December '09, when the WH and congressional democrats were meeting for the conference committee and crafting the final bill, there was tons of reporting saying the final bill wouldn't have a PO but would have a national exchange from the House plan.

      Scott Brown's victory screwed that up because with the Senate Democrats no longer having 60 votes, passing a new plan out of conference was not a possibility. What they needed was for the House to pass the Senate plan, but then also pass a reconciliation amendment plan to make changes, which the Senate would then pass with the necessary 51 votes.

      The problem was anything reconciliation related must be budgetary, so structural changes to government like new exchanges cannot be passed. That limited the only changes possible to the Senate plan being increases in the subsidy levels and a more generous financial support system, which is what happened. I remember this episode well, cause it pissed me off.  

      •  Of course they had a choice (5+ / 0-)
        Recommended by:
        a2nite, splashoil, cpresley, YucatanMan, cdreid

        and yes, I recall the 51 votes.  The state give-away system wasn't required to get it passed.

        The giveaway to states didn't pick up any votes for them, they managed to get it passed in spite of them.

        It was a story of failed political bribery, pure and simple.   They ladled out tens of billions to states for governors to give away to their friends and donors (who they appointed to all the special commissions, boards, etc.) when they could have used that money to keep programs like the high risk insurance pool afloat.

        In GOP states, the Republicans simply laundered the federal money into their own campaign coffers and used it to gerrymander the vote and run against Dems.

        Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

        by Betty Pinson on Mon Feb 18, 2013 at 10:00:30 AM PST

        [ Parent ]

    •  Because (1+ / 0-)
      Recommended by:
      cdreid

      Harry Reid's biggest donor group is the health industry - really surprised that this conflict of interest didn't get more coverage during the original HCR process.

      •  The truth is (0+ / 0-)

        the healthcare industry is the most powerful lobby in washington period. The number of md's in the house and senate is shocking and that doesnt count insurence execs, etc. The AMA is probably the most powerful political organisation in the US.

        And which side of the divide most those upperclass, white, older, mostly from families of wealth people fall on.

        A man is born as many men but dies as a single one.--Martin Heidegger

        by cdreid on Tue Feb 19, 2013 at 08:03:07 AM PST

        [ Parent ]

  •  the deadline is a problem (4+ / 0-)

    and another potential opportunity for the Republicans to point at how government doesn't work.

    But, on the other hand, as mentioned,  the upside of huge market share for federal exchanges offers real opportunities for all of us to benefit in the long run.

    •  on the other hand, the federal govt tends (1+ / 0-)
      Recommended by:
      jfromga

      to be very good at massive IT projects. So, we'll see how it comes along.

      •  HAH (0+ / 0-)

        Omg no they dont. This is the organisation that singlehandedly kept COBOL alive for decades after it should have died. Their are fed and state government systems that STILL use telnet systems with hardlines.

        A man is born as many men but dies as a single one.--Martin Heidegger

        by cdreid on Tue Feb 19, 2013 at 08:04:17 AM PST

        [ Parent ]

        •  they may not have funds for massive rebuilds but (0+ / 0-)

          they do build some of the most complex systems ever tried - nasa, irs, economic indicators, etc

          •  Actually (0+ / 0-)

            the most complex systems are done at universities. Theyre usually done in electronic engineering departments or crossover engineering/csci departments. The irs screwed around til private industry created systems to do what it should have done a decade before then played catchup. Wall street was building systems to manage and predict the markets ages ago and the government hasnt even caught up on regulation much less ocmputer systems.

            The government is a joke when it comes to computer science which is odd considering it has a metric f'ton of the most overly paid it/csci people.

            The only thing nasa did that was extraordinary is their data transmission systems which were astonishing even 25 years ago. But then again the public never saw any benefit out of that as nasa's default position is keep everything to itself and fuck the public (which is one reason theyre in hardcore trouble now).

            A man is born as many men but dies as a single one.--Martin Heidegger

            by cdreid on Mon Feb 25, 2013 at 04:11:39 PM PST

            [ Parent ]

  •  Another advantage to the federal exchange (9+ / 0-)

    While it will be difficult to set up, better to have someone working to create the exchange that actually wants it to succeed rather than a conservative governor who doesnt like the law.

  •  I can't believe (7+ / 0-)

    that the administration is surprised by this. Perhaps I am being too hopeful, but it seemed inevitable that most red states would respond this way and that the gov't is prepared for it.

     Time will tell, but i am assuming that they have been working toward this all along, so it is not as though there's only a few months to accomplish it.

     As a citizen of Maine, laboring under the appallingly horrid Teabag Gov. LePage, I would MUCH rather have my healthcare planning in Federal hands.

     It may be a messy beginning, but I think it will prove a blessing in the end, for the reasons advanced, larger pool, more uniformity and etc.

    “Good things don’t come to those who wait. They come to those who agitate!” Julian Bond

    by Dvalkure on Mon Feb 18, 2013 at 10:07:06 AM PST

  •  I'm delighted that my teabagger governor (6+ / 0-)

    won't be running the exchange in Wisconsin.

  •  Will they "sequester" the funding (1+ / 0-)
    Recommended by:
    cmoreNC

    ..for the federal exchanges?

    •  Exactly. How many times as house voted to repeal (2+ / 0-)
      Recommended by:
      Losty, kareylou

      ...the entire ACA since it was passed?  Since they don't have the votes in the Senate and don't have the Presidency, and thus cannot successfuly repeal the law, they will try to starve it by steadfastly refusing to fund it.

  •  We can't afford the "high risk" insurance pools (10+ / 0-)

    but we can afford to waste money on building state exchanges instead of just having one federal exchange.

    Funds run low for health insurance in state ‘high-risk pools’

    The amateurs in DC who come up with these bad policies in the name of "winning votes" need to accept that their failure to use common sense in health care policy actually ends up killing people.

    While it might enhance their career prospects in the private sector and is fun to talk about after work at the martini bar, at the end of the day it just causes people to suffer and die unnecessarily.  

    But, as they say, its ok to throw people overboard as long as you don't have to hear the splash.

    Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

    by Betty Pinson on Mon Feb 18, 2013 at 10:50:54 AM PST

  •  So...how good can it get? (3+ / 0-)
    Recommended by:
    ban nock, leu2500, RJDixon74135

    (I hate comments that begin with "so")...

    I want so much to have a public option...and given the apathy of progressives, letting the GOP take over the 2010 elections, our best bet is to have a public option appear in the exchanges.

    And due to the stupidity of a bunch of GOP governors, leaving the exchange to the Feds, it may actually be possible.

    Note to GOP (please don't bother to read, as you didn't learn that skill as a home-schooler anyway)....

    If people see how great a public option is, they will gravitate to it over time.

    If a public option competes with profit-motivated commercial health care, it will lose every time.

    If you continue to be the party of "stupid," you will join T. Rex.

    •  Apathy of Progressives (2+ / 0-)
      Recommended by:
      kareylou, cdreid
      given the apathy of progressives, letting the GOP take over the 2010 elections

      The healthcare reform laws that created the exchanges and everything else instead of a universal public insurer passed in 2010, prior to the elections you're complaining about.

      What are you talking about? Just an imaginary opportunity to attack progressives along with Republicans who are to blame for both bad laws and voting for the idiots who make them.

      "When the going gets weird, the weird turn pro." - HST

      by DocGonzo on Mon Feb 18, 2013 at 07:09:35 PM PST

      [ Parent ]

      •  The governors (0+ / 0-)

        who are largely refusing to fill the Medicaid gap, were mostly elected in 2010.

        •  Apathy of Progressives (0+ / 0-)

          How did "apathy of progressives"  get these governors elected in states mostly Republican-voting for many years?

          "When the going gets weird, the weird turn pro." - HST

          by DocGonzo on Tue Feb 19, 2013 at 04:28:23 AM PST

          [ Parent ]

          •  I have the data! (0+ / 0-)

            Been working in Michigan where we have data on how many retired union members didn't bother to vote in '10. That number alone would have prevented Snyder and Right to Get Paid Less from the state.

            '10 was the election of progressive apathy, I can assure you.

            •  People can't have it both ways (1+ / 0-)
              Recommended by:
              MsTribble

              I can't tell you how many "Obama just didn't do it for me. It's his fault that we lost the 2010 elections" comments, but then at the same time those people will say "it's not our fault, progressives were all fired up in 2010!"

              Look, we screwed up collectively. We weren't as fired up as we SHOULD have been, even if we weren't apathetic or whatever you want to call it, and it burned us and burned the country.

              As Hillary Clinton would say - what difference does it make now? Lets work on not having a repeat of this in 2014 and maybe we can get something done!

              When we stop putting leaders from the past up on pedestals and ignoring their flaws, we can start seeing our present leaders for what they really are.

              by PhillyJeff on Tue Feb 19, 2013 at 06:28:15 AM PST

              [ Parent ]

            •  The Data (0+ / 0-)

              So how many people voted Republican in Michigan in 2010 vs how many in 2008?

              "When the going gets weird, the weird turn pro." - HST

              by DocGonzo on Wed Feb 20, 2013 at 04:42:47 AM PST

              [ Parent ]

  •  Mostly GOP States leaving it to the Feds because (4+ / 0-)
    Recommended by:
    ban nock, leu2500, Losty, DocGonzo

    They are basically unable to govern or administer programs appropriately.

    I don't know what consciousness is or how it works, but I like it.

    by SocioSam on Mon Feb 18, 2013 at 06:38:05 PM PST

  •  YAY! Red States are choosing Federal (5+ / 0-)

    Healthcare!   Single payer can't be far off now.

    We will never be free from fear as long as we fear the NRA.

    by captainlaser on Mon Feb 18, 2013 at 06:38:19 PM PST

  •  Now I wish I lived in a red state (2+ / 0-)
    Recommended by:
    leu2500, kareylou

    so I could be on the national plan.

    Remember, single provider is the goal, not just single payer.

    How big is your personal carbon footprint?

    by ban nock on Mon Feb 18, 2013 at 06:42:11 PM PST

  •  Well now, wasn't it always a conservative bitch (4+ / 0-)

    That consumers couldn't buy insurance "Across state lines"? Yes I am well aware that they were merely doing the bidding of their deep pocketed sponsors, the insurance companies, and don't really give a curse about actually providing affordable insurance to most people. Still, now don't they have  what they want, and shouldn't they be happy?

    An empty head is not really empty; it is stuffed with rubbish. Hence the difficulty of forcing anything into an empty head. -- Eric Hoffer

    by MichiganChet on Mon Feb 18, 2013 at 06:42:20 PM PST

  •  If memory serves........................... (2+ / 0-)
    Recommended by:
    Notreadytobenice, ban nock

    and I will admit to increasing occurances of "senior moments;" isn't it required that all exchanges will have at least one "not-for-profit" insurance option?  So it shouldn't all come down to corporate profits.

    The mass of men lead lives of quiet desperation--HDT

    by cazcee on Mon Feb 18, 2013 at 06:46:08 PM PST

  •  Why not make it a division of Medicare? (5+ / 0-)

    The organizational structure is already there.

    •  Exactly (1+ / 0-)
      Recommended by:
      kareylou

      My significant other 's Medicare ask what state you are in and then had like 12 plans.  You chose your plan and compared insurance companies (supplemental coverage) and price same for Part D.

      I don't understand why using that framework won't work for National Exchange?

  •  There's just no way in hell this gets up and (0+ / 0-)

    ... running before October 1. They'll have to postpone the deadline. This is a massive undertaking.

    That said, if they can get it to work (even if they're late in getting it operational) all of these Republicans may be regretting letting the feds practically nationalize the process.

    •  I worked at HHS (1+ / 0-)
      Recommended by:
      Bob Johnson

      And the plans are to use the existing Federal Insurance Exchange --

      The Federal Employees Health Benefits Program (opm.gov)

      There are several nationwide plans (BC/BS, GEHB, etc.) and many that cover specific regions of the country. OPM puts up comparisons of the plans every year. Open Season for Federal employees is in December.

      HHS and OPM will be involved the the administration of this system.

      •  I hope so. (0+ / 0-)

        That'd be great if they could get up and functioning by October. The Republicans will crap their drawers if the feds successfully implement the program and it proves effective and popular.

        •  It's already "up and functioning" (1+ / 0-)
          Recommended by:
          Bob Johnson

          It's been in existence for about forty years, serving Federal employees and their families.

          •  But I mean linking in whatever else needs to be (0+ / 0-)

            ... linked in to make it work. I read that there are a myriad of state rules and such that govern insurance companies that may impact system deployment.

            •  Those insurance companies are already... (0+ / 0-)

              ...in compliance. That's why there are different providers (i.e., insurance companies) in different states.

              There are a handful of companies in FEHB that operate nationwide. The only way they can do that is to be in compliance with every state's regulations.

              Are you worrying about the software? That's already there as well -- I can change my enrollment during open season on-line or by filing a form (snail mail) with OPM.

  •  Gee who could have seen this coming? (0+ / 0-)

    "Setting up a system for 25 states puts a strain on the federal government that wasn't really planned for in the development of the law."

  •  I Am Paying for Republican Welfare (1+ / 0-)
    Recommended by:
    kareylou

    All that extra work for the Federal government is going to cost more in taxpaid budgets. My taxes pay those budgets. But I'm not going to get any benefit. New Jersey, Ohio, all those dozens of Republican states are getting a "free ride" that we're all paying for but only they are getting. Plus along with everyone else in NY I'm paying more to the Feds already than I'm getting back.

    OK, this is just yet another example of Republicans being the very welfare queens they demonize when they lie about it being someone else.

    But that joke's not funny anymore. Instead of this increasing travesty, we should just have Medicare for All. Goddamn it.

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Mon Feb 18, 2013 at 07:02:31 PM PST

    •  I live in NJ and as a donor state, (1+ / 0-)
      Recommended by:
      MrJersey

      it's about time we got something back.

      Christie probably voted for the Feds so he could run against it in a Repuke primary (makes sense when you consider how Repukes think), but the overall result is good IMO. I trust the Feds more than I trust any Teabagger.

      A village can not reorganize village life to suit the village idiot.

      by METAL TREK on Mon Feb 18, 2013 at 09:58:11 PM PST

      [ Parent ]

      •  I Pay in NY (0+ / 0-)

        As a donor state, NY is not getting anything back. NY "donates" a lot more than NJ does.

        Me paying for a lot of deadbeat Republicans and some fellow "donors" doesn't make this any better for me. It's always better for the takers.

        Giving to this private insurance marketing scheme while I pay (ever more) for my own private insurance in NY, but there's no universal coverage, is the worst of all worlds for me. And for the other half of the states who are paying both ends like I am now - the majority of the people.

        I'd be much happier "donating" to Medicare for All, which at least didn't have the unearned profit bilked from me by the cartel, with an inefficient and toothless Federal administrator doing the marketing and organization for free, with its own waste and frauds built in.

        "When the going gets weird, the weird turn pro." - HST

        by DocGonzo on Wed Feb 20, 2013 at 05:23:33 AM PST

        [ Parent ]

  •  I kind of wish all states let the Feds do it. (2+ / 0-)
    Recommended by:
    ban nock, kareylou

    As you say, it brings us closer to a national model to build on.

    "Michael Moore, who was filming a movie about corporate welfare called 'Capitalism: A Love Story,' sought and received incentives."

    by Bush Bites on Mon Feb 18, 2013 at 07:07:49 PM PST

  •  That map (2+ / 0-)
    Recommended by:
    peregrine kate, kareylou

    looks very familiar.

    I am not religious, and did NOT say I enjoyed sects.

    by trumpeter on Mon Feb 18, 2013 at 07:12:48 PM PST

  •  Mass. Health Care Reform wiki: (1+ / 0-)
    Recommended by:
    RJDixon74135

    http://en.wikipedia.org/...

    The Massachusetts health care insurance reform law, St. 2006, c.58, informally referred to as Romneycare, is a state law enacted in 2006, signed into law by then-governor Mitt Romney. The law mandates that nearly every resident of Massachusetts obtain a state-government-regulated minimum level of healthcare insurance coverage and provides free health care insurance for residents earning less than 150% of the federal poverty level (FPL). The bill aimed to cover 95% of the state's 500,000 uninsured within a three-year period. The law was amended significantly in 2008 and twice in 2010 and major revisions related to health care industry price controls were introduced in the Massachusetts legislature in May 2012 that passed in August 2012.
    Go the Mass. Connector and check it out:
    https://www.mahealthconnector.org/...

    One can go through the steps as if you were choosing.
    Last year price controls were introduced.
    Seems to be working; maturing and well liked.
    >99% of our kids are insured.

  •  asdf (1+ / 0-)
    Recommended by:
    Losty
    It could be the model that shows a national health care system works, taking us one step closer to a public national health care system.
    Lets not kid ourselves - best case scenario doeasn't bring us within a country mile of a public healthcare system. That cannot happen while the insurance industry have a seat at the table. It is not complicated.
  •  50 percent of the way toward (2+ / 0-)
    Recommended by:
    khyber900, METAL TREK

    A public option.  That is all we need now and many of the other 25 will also allow a public option.

    Once again the GOP cry babies have overplayed their hand and have given us an opening toward true universal health care.

    "The real wealth of a nation consists of the contributions of its people and nature." -- Rianne Eisler

    by noofsh on Mon Feb 18, 2013 at 07:16:32 PM PST

  •  and remember (0+ / 0-)

    members of congress have to purchase their insurance thru the national exchange as well..

    "Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservative." - John Stuart Mill

    by smartone on Mon Feb 18, 2013 at 07:20:08 PM PST

  •  This way all criticism will go to the Feds.... (3+ / 0-)

    ....for any long waits, any names that misspelled, any eligibility disputes, any problems. They want the Post Office to fail, they want this to fail and they want all government just to get the fuck out of the way.

    Their method: sabotage.

    If you hate government, don't run for office in that government.

    by Bensdad on Mon Feb 18, 2013 at 07:23:23 PM PST

  •  the irony of that map... (3+ / 0-)
    Recommended by:
    ferg, kareylou, METAL TREK

    the states rights crowd opening NOT to develop programs locally and default to the Feds...  in the name of not cooperating with the Feds...

    Join Soulforce-seeking Justice for God's GLBT children.

    by its simple IF you ignore the complexity on Mon Feb 18, 2013 at 07:34:12 PM PST

  •  guvmint is not the solution. (1+ / 0-)
    Recommended by:
    khyber900

    Federal government is.

    An honest heart being the first blessing, a knowing head is the second..Jefferson's Letter to Peter Carr

    by JugOPunch on Mon Feb 18, 2013 at 07:40:07 PM PST

  •  Isn't it ironic that all these states with nutcase (1+ / 0-)
    Recommended by:
    RJDixon74135

    governors who "hate federal interference" are opting to have no input at all and allowing the federal government to provide services directly to their citizens without state interference?

    Could this be the beginning of the end of these state's redness?  At the very least, it's  going to be a new dynamic once the federal program starts up.

    "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

    by YucatanMan on Mon Feb 18, 2013 at 08:41:38 PM PST

    •  I'd say it's a beginning. I can't believe they (1+ / 0-)
      Recommended by:
      YucatanMan

      just shot themselves in their collective foot in this way.  But hey, it's a win for our side.

      The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

      by helfenburg on Tue Feb 19, 2013 at 03:48:54 AM PST

      [ Parent ]

  •  With the feds (0+ / 0-)

    now in the position to run half of the states exchanges,the anti ACA idiots have pushed us towards something they really don't want....NATIONAL HEALTH CARE!!!! Thanks a lot dumbasses,really,THANK YOU.

  •  Mostly pretty partisan, but a few exceptions (0+ / 0-)

    I guess Christie is just crazier than the Utah and Idaho Republicans.

    "Victory means exit strategy, and it's important for the president to explain to us what the exit strategy is." - George W Bush

    by jfern on Mon Feb 18, 2013 at 09:33:52 PM PST

  •  I don't see how this is not a good thing. All (0+ / 0-)

    those millions of voters in red states having direct experience of how the federal government works to improve their lives and their health care.  Sounds like the Repubs have missed the boat as usual.

    The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

    by helfenburg on Tue Feb 19, 2013 at 03:44:51 AM PST

  •  Since it is primarily the South passing on ACA (0+ / 0-)

    they are hoping when the Feds start providing health care for their poor sick citizens the Feds will give poor care and thus proving "Obama Care does not work, see we proved it"

    These governors are despicable humans.  

    But I must ask, Are they really Christian?

    Psst!!!......Mittens you are more of a poor loser than I thought.

    by wbishop3 on Tue Feb 19, 2013 at 04:26:10 AM PST

  •  The clowns "against big gov't" just welcomed it (0+ / 0-)

    I really don't see how anybody on the left or right can take  anything the Repubs say seriously, or as anything close to the truth.  Maybe all the gun-toting bible-thumping racists hear different words from what is actually said, because of a roaring cacophony of interior mental ranting that drowns out any input. But really ... when the Repub leaders say one thing one day, then completely contradict themselves later in the same day, what idiot still believes in them?

    Ash-sha'b yurid isqat an-nizzam!

    by fourthcornerman on Tue Feb 19, 2013 at 05:28:25 AM PST

  •  The IRS is already implementing this (1+ / 0-)
    Recommended by:
    tb mare

    And they are completing transaction-based (vs file transfer) systems with HHS and the states to support this. You better believe the government is right on top of this. I know because I'm working on this.

    "There's a fine line between clever and stupid." This Is Spinal Tap

    by ebirch1 on Tue Feb 19, 2013 at 06:45:36 AM PST

  •  The Federal Employees Health Benefits exchange (0+ / 0-)

    has operated efficiently for at least forty years.  Participating insurance organizations vary by states.  For example, some plans are available nationwide, and others only in some states.  Others offer variations in different states.  It would seem like a starting point for the exchanges the Federal Government has to construct.  Ultimately, I am confident that HHS can develop effective programs.

    It's somewhat ironic that all of the Confederacy, except Arnkansas, has opted for a Federal operation.  I know the intent is "malevolent compliance", but I believe ultimately it will be obvious that the holdouts were self defeating.

    •  Feds will expand FEHB (0+ / 0-)

      Right before I retired at HHS, the powers that be put the word down the line that FEHB is going to the the Federal exchange.

      When I questioned our auditors about this, one of them grinned and said he wouldn't be surprised if our premiums decreased, since the insurance companies taking part in FEHB would be getting a huge influx of people. More people = more premium payments.

      HHS has been gearing up for this since ACA passed. OPM has been managing FEHB for all the time I was an employee (33 years), and I never had a problem with their end of the system.*

      *I have had to have words with my insurance company over things that were covered that they didn't want to pay for -- the worst one I had to make three phone calls to straighten out. And yes, the company DID end up paying their share.

      •  That's good to hear. (0+ / 0-)

        I retired from the FAA with 36 years at the beginning of 2007.  I was always proud of the way the FEHB worked, and still am.

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