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Tom Baxter

Health insurance exchanges: the upside-downness of left and right

To appreciate how upside down our left-right politics has become, consider the current dust-up over health insurance exchanges.

They started out as a hot topic on the Republican neo-conservative salon circuit, promoted as an innovative way to involve free-market concepts in solving the problems of medical insurance costs. Since getting incorporated into ObamaCare, however,  the term “health insurance exchanges” has come to connote something as iniquitous as “wife-swapping” on the Republican stump.

Conservatives argue that as shaped by the Obama administration, the exchanges have become so overburdened with regulations they no longer reflect the original idea. That’s  the basic objection raised by Gov. Nathan Deal in announcing his decision to reject the invitation for the state to set up its own exchange to go into operation in 2014, and instead let the feds and set it up.

Supporters of the bill argue the regulations amount to consumer protections that a lot of states already have in place. However you come down on it, there are going to be exchanges in all the states, now that the election has removed any doubts about the survival of the Affordable Care Act. So by asserting their states’ independence, Deal and the other governors who have rejected the invitation to set up their own plans are opting to let federal bureaucrats come in the state and do it for them.

Upside down? Diana Ross didn’t sing it any better.

For the average consumer who needs health insurance, it isn’t likely to matter that much whether the exchange – basically, a website for people to go and shop health insurance plans, and the administrative staff which polices the plans and decides of them get in the marketplace – is run by the state or federal government. But states which have moved to set up their own plans, such as Maryland and California, will have a far better chance to fine-tune their programs than the states which rejected the opportunity.

“A lot of states were playing chicken with the feds,” said Cindy Zeldin, executive director of Georgians for a Healthy Future.

The Republican governors who passed on the exchanges were presenting a solid front against ObamaCare, counting on Mitt Romney to win the election. Some, like Deal, are holding firm on the issue, while others, like Florida Gov. Rick Scott, have begun to look for wiggle room.

“Just saying no is not an answer,” Scott, formerly a staunch opponent of the exchanges, said last week, without saying just what he might say yes to.

The deadline for the states to declare whether they were setting up exchanges was Friday, but late Thursday, at the request of the Republican Governors Association, Health and Human Services Secretary Kathleen Sebelius pushed it back to Dec. 14.

That gives the still undecided Republican governors, such as Jan Brewer of Arizona and Chris Christie of New Jersey, time to come around. But there really isn’t much incentive for the Republicans who have already rejected them to stand down on the exchanges,  because the big walk-back looms just beyond this one, on the issue of whether to accept the Medicaid expansion which is the most vital part of the Affordable Care Act.

When the U.S. Supreme Court upheld the Affordable Care Act while opening the door for the states to challenge the Medicaid expansion component, it put the governors in a tight political spot. They may reason they have nothing to lose by opposing the exchanges, which are coming anyway, but they stand to lose billions that their hard-pressed healthcare delivery systems need if they reject the Medicaid expansion.

The intramural fight over the upcoming reauthorization of the hospital bed tax has diverted attention from the issue temporarily here in Georgia, but you can expect the hospitals to begin very shortly making the case that playing ball on the Medicaid expansion amounts to a matter of survival.

Deal has already staked out a position strongly opposed to that aspect of ObamaCare as well, arguing that while the feds would pay all the costs of the expansion over the first three years, the state can’t afford the greater burden imposed by the law. But when an issue involving this much federal money is involved, he can expect a lot more blowback than he’s weathered on the health insurance exchanges.

Tom Baxter

Tom Baxter has written about politics and the South for more than four decades. He was national editor and chief political correspondent at the Atlanta Journal-Constitution, and later edited The Southern Political Report, an online publication, for four years. Tom was the consultant for the 2008 election night coverage sponsored jointly by Current TV, Digg and Twitter, and a 2011 fellow at the Robert J. Dole Institute of Politics at the University of Kansas. He has written about the impact of Georgia’s and Alabama's immigration laws in reports for the Center for American Progress. Tom and his wife, Lili, have three adult children and seven grandchildren.



  1. julieanderson2912 November 23, 2012 5:44 am

    It just convince us that all the policies has been changed entirely!

  2. rebbicajackson1 December 4, 2012 2:54 am

    Health care exchange became very big issue for US government and people. Advantages are more by health care exchange. 

  3. Amber Morgan March 27, 2013 2:41 am

    Every single person needs a perfect health insurance plan that ultimately helps them in various stages such as during health falls and illness. A perfect health insurance plan is more beneficial for getting profitable health coverage and compensation. But in the above post we have found various debates on health insurance ups and downness that helps to understand what steps should be taken to get health insurance coverage.Report


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