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Map of states implementation of health exchanges under Affordable Care Act.
Now that the Affordable Care Act really is the law, the battle ground has moved to the individual states, and the combatants are now all Republicans.
Mississippi Insurance Commissioner Mike Chaney informed HHS Secretary Kathleen Sebelius Nov. 14 that he will oversee the creation of a health insurance exchange despite the objections of Gov. Phil Bryant. On Monday, in a previously unreleased letter, Bryant wrote Sebelius to say he “feels compelled to notify you of my complete disagreement with this move.” [...]

“The governor asked me, ‘What authority do you have to do this?’” Chaney told POLITICO. “And I said, ‘Phil, what authority do you have to stop me?’” [...]

In Kansas, Republican Insurance Commissioner Sandy Praeger — a proponent of creating a health care exchange — devoted two years to an application enabling the state to partner with HHS. On Nov. 8, GOP Gov. Sam Brownback said the state would not create an exchange. [...]

Despite Brownback’s action, Praeger said she intends to press for a state-based or partnership exchange for the remainder of her term, which expires in 2015. [...]

Michigan GOP Gov. Rick Snyder spent months planning a state exchange, which passed the GOP-controlled state Senate but not the state House. On Thursday, a Republican-dominated state House committee killed Snyder’s exchange legislation, leaving the governor unable to impose one. [...]

In Idaho, Republican Gov. Butch Otter supports a state-run exchange — but the GOP-led state Legislature doesn’t. State Rep. Lynn Luker compared state-based exchanges to children’s theater in which the state has the illusion of control but federal overseers are really pulling the strings. [...]

In Tennessee, GOP Gov. Bill Haslam is weighing the idea of creating an exchange while Republicans are pressuring him not to do so. His spokesman, David Smith, said Haslam, “is reviewing the information as it comes and continues to seek answers to a number of unanswered questions.”

In many instances, there are actual, real public servants who want to make government work and see this as an opportunity to help relieve some of the very real burden on states to provide health care coverage. Yes, there are even some Republicans, like Mississippi's Chaney, who want to do their jobs. In Chaney's case, he can. He has broad authority under state law to unilaterally move forward, without interference from the governor or legislature. But he's pretty much in the minority in both terms of commitment to his job and ability to do it.

In some cases, as in Idaho, the governor has some ammunition. Otter convened advisory committees on both the exchanges and Medicaid expansion, and both groups full embraced moving forward because of the savings the state would gain. But Idaho's legislature is kind of crazy, so all bets are off.

But the very real pressures of trying to provide health care affordably to state populations is enough to make this a high-stakes fight. Again. At least this time it's mostly Republican versus Republican.

Originally posted to Joan McCarter on Fri Nov 30, 2012 at 02:28 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Food fight! (13+ / 0-)

    This is where we see difference between Republicans who are interested in governing vs the ones who are just there for the power.

    Filibuster reform now. No more Gentleman's agreements.

    by bear83 on Fri Nov 30, 2012 at 02:39:44 PM PST

    •  Iowa would have been better off defaulting (6+ / 0-)

      To the Feds.  Insurance companies so control the state legislature -- party be damned -- that we can be confident they will slant the state exchange to benefit the providers.

      "Let's see what fresh fuckwittery these dolts can contrive to torment themselves with this time." -- Iain Banks, The Hydrogen Sonata

      by Rikon Snow on Sat Dec 01, 2012 at 04:26:20 PM PST

      [ Parent ]

      •  Minnesota (4+ / 0-)

        A friend who works for a big insurance co told me today the state is giving them no wiggle room, telling them what to do and they plan to be ready in the fall. Love MN healthcare.

      •  can they do that? (0+ / 0-)

        I was under the impression there were fairly strict requirements for how the exchange is to be run.

        Granted, I was surprised to see Iowa (my home state) in that column at all. I'd figured for sure Branstad and the gop in the assembly would push it off on the feds.

        "There is one rule for the industrialist and that is: Make the best quality of goods possible at the lowest cost possible, paying the highest wages possible." -Henry Ford

        by sixeight120bpm on Sat Dec 01, 2012 at 07:18:08 PM PST

        [ Parent ]

        •  Leaving the exchange to the feds (0+ / 0-)

          is a major expansion of the federal government as a direct provider of services to the American population.

          Healthcare is not a state-by-state problem. It's a national problem. If you want decent healthcare coverage you have to know in advance what the rules are. How do you find out what your coverage is? Who do you appeal to if it is denied and what are the procedures? If you want to see a real rat's nest of private enterprise with no central administration take a look at the Part D of Medicare together with Medicare Advantage Plans, both of which take administration away from any central authority and give it to private insurers in regions all over the country. That was the 2003 Medicare Expansion Act passed under GW Bush and the Republican Congress because private insurers were all dropping coverage for pharmaceuticals.

          How has that worked? Frank Lalli tells his story in the New York Times.

          Solving the problems of health care financing is not something that locals can do individually and compete. No one knows what the contracts they buy will cover in the future, and the only purpose of leaving the regulation at the state level is to create a series of health insurance monopolies with monopoly pricing and large numbers of uninsured outside the system. A few people get very rich, and a lot of people die to let that happen.

          Rick Perry signed a letter to the feds telling them Texas would not establish a health insurance exchange. It's the best decision he has made for Texas since GW Bush donated the governorship to him in 2001. The Texas conservatives have repeatedly proven their total incompetence to run government, so Rick Perry has invited the competent people from the federal to come in and run the health insurance exchange.

          Calling for the federal government to run these exchanges allows the federal professionals to provide government services directly to the population, much as the Post Office has always done. We Texans are lucky that Rick Perry is too stupid to understand that.

          The US Supreme Court has by its actions and rhetoric has ceased to be legitimate. Whiskey Tango Foxtrot - over

          by Rick B on Sun Dec 02, 2012 at 07:36:24 AM PST

          [ Parent ]

    •  I loves me some GOP civil war....... (2+ / 0-)
      Recommended by:
      bear83, Matt Z

      Messy,sometimes nauseating, never boring and always benifits the public good as casualties on both sides mount and the party shrinks......

       Eventually the resistance to the state exchanges will crumble in the face of overwhelming dollars and those embitterd opponents will slink off as the party fractures even further.

       Eventually a third party consisting of the dissafected wingers will rise to do battle with the remnants of the party base, ensuring that the Demcratic Party will continue to pick off House seats and gradually reclaim state legisltures.

       It leaves open the question of what exactly are the early runners for '16 going to see by the time the 2016 GOP convention convenes.

      it tastes like burning...

      by eastvan on Sat Dec 01, 2012 at 05:31:05 PM PST

      [ Parent ]

  •  My understanding is that some of the Republican (16+ / 0-)

    Governors and state legislatures not only oppose setting up the exchanges but are refusing to accept Federal funds to expand their state Medicaid programs which is going to be hard to explain to voters - why the eligible poor are going to be denied free health care coverage.

    If states refuse to set up the exchanges apparently the Federal government can step in and do it for them since all states are required to have these operational by Oct of 2013, for implementation  of the ACA January 1, 2014.

    But, apparently the Supreme Court said we can not force the states to expand their Medicare coverage to the 133% of the poverty rate, (or was it 150%) called for in the ACA.

    This will leave a big hole in our coverage plan that we need to place the blame for squarely on the shoulders of these selfish GOP Governors.  

    The means is the ends in the process of becoming. - Mahatma Gandhi

    by HoundDog on Fri Nov 30, 2012 at 02:42:13 PM PST

    •  They won't care. Never have. Never will. (11+ / 0-)

      There are those that look at things the way they are, and ask why? I dream of things that never were, and ask why not? - Robert Kennedy

      by BobBlueMass on Fri Nov 30, 2012 at 02:45:52 PM PST

      [ Parent ]

    •  It will be hard to explain to the medical (7+ / 0-)

      profession and the health care business, which are going to campaign for the exchanges and for Medicaid expansion.

      This same fevered opposition arose against the original Medicaid. How many states do you suppose have not implemented it today? You get one guess.


      In case any numerically-challenged Republicans ask:

      "Did you count them?"


      Douglas Adams, HHGTTG

      It is time to cue the circular firing squads. Again.

      America—We built that!

      by Mokurai on Fri Nov 30, 2012 at 05:52:43 PM PST

      [ Parent ]

      •  Arizona was the last state to completely (1+ / 0-)
        Recommended by:
        Sherri in TX

        implement Medicaid - in 2001.  It took the state several partial steps from 1982 to 2001.

        "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

        by SueDe on Sat Dec 01, 2012 at 04:22:26 PM PST

        [ Parent ]

      •  Agreed (1+ / 0-)
        Recommended by:
        Rick B

        Once they start hearing from the hospitals and docs, most governors will agree to accept Medicaid expansion. Most of the statements that they would turn it down were made before the election. They were betting that Romney would be elected and ObamaCare would be repealed or rendered worthless in its implementation.

    •  A common mistake - you are talking about (3+ / 0-)

      Medicaid expansion, not medicare.  Medicaid is a program for the poor (of any age), medicare is for seniors and the disabled.

      my daughter (25) has both medicare and medicaid (medicare covers hospitilazation and medicaid covers the rest).  anyone with medicare needs to buy a 'Part B' to cover doctors visits and a prescription plan, in my daughter's (unemployed) case, medicaid picks up both of those.

      "Don't Bet Against Us" - President Barack Obama

      by MRA NY on Fri Nov 30, 2012 at 09:41:58 PM PST

      [ Parent ]

    •  Welcome to Texas. (2+ / 0-)
      Recommended by:
      Rikon Snow, Brooke In Seattle

      No state-run exchange, no expansion of Medicaid.

      "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

      by SueDe on Sat Dec 01, 2012 at 04:08:34 PM PST

      [ Parent ]

      •  It's ok. You'll be better off with the federal (2+ / 0-)
        Recommended by:
        Mayfly, Rick B

        Exchange.   The states are already responsive to insurance company priorities in setting up their "sovereign" exchanges.

        "Let's see what fresh fuckwittery these dolts can contrive to torment themselves with this time." -- Iain Banks, The Hydrogen Sonata

        by Rikon Snow on Sat Dec 01, 2012 at 04:38:16 PM PST

        [ Parent ]

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

          Texas government has repeatedly demonstrated that it is incompetent to govern. They could not organize a voluntary dog fight with willing angry dogs. The feds have proven with Medicare and other health programs like VA that they can effectively manage the health system, so Rick Perry has notified HHS Secretary on Nov 16th to come in and set up the exchange.

          Since one in four Texans have no health insurance the county hospitals tax the homeowners to pay for the healthcare those individuals receive, but it has meant that smaller hospitals have been going bankrupt or merging with larger systems. No sane hospital administrator in Texas is going to let the conservative Republicans screw up as badly as they are promising to do.

          At the same time, the media is so starved for funds that they have no experts who know how to report on this issue, so we in the public will not see much of the in-fighting that is already going on.

          This stuff on health care has been a long battle. Few people realize that Medicaid was included in the original Medicare law to replace the originally proposed pharmaceutical benefit, because the drug companies did not want to have to negotiate prices with the federal government and promised to kill LBJ's total Medicare program if they were included. This all happened in the House Ways and Means Committee.

          The US Supreme Court has by its actions and rhetoric has ceased to be legitimate. Whiskey Tango Foxtrot - over

          by Rick B on Sun Dec 02, 2012 at 07:54:42 AM PST

          [ Parent ]

  •  I wonder if Chris Christie had anything to do with (8+ / 0-)

    this? Inadvertently, of course. Maybe some of these state GOPers noticed Christie's approval rocket upward after he cooperated with President Obama during Sandy. Blind intransigence may have run its course.

    •  don't think so (12+ / 0-)

      I think this is a clash between 2 perspectives in the R party:

      The Grownup: I don't like the law, but we will have to have an exchange according to the law.  We have a choice on whether we want to build our exchange and do it on our terms with our oversight and our rules or leave it up to the feds so its better to do it and maintain control.

      The 2 Year Old:  You can't make me, nyah nyah nyah.  I dare you to create a federal exchange.

      Unfortunately there are way too many 2 year olds.

      •  There are those states that say the federal rules (1+ / 0-)
        Recommended by:

        for exchanges are too onerous and nit-picky.

        Which to me says the fed rules are meant to help as many people as possible. This idea, of course, is anathema to Rs.

        "I believe more women should carry guns. I believe armed women will make the world a better place. Women need to come to think of themselves not as victims but as dangerous." Anna Pigeon

        by glorificus on Fri Nov 30, 2012 at 09:13:33 PM PST

        [ Parent ]

      •  or fortunately (2+ / 0-)
        Recommended by:
        blue denim, Sherri in TX

        Because a federal exchange is what progressives generally wanted, precisely to keep Republican states from screwing them up.

        •  If you want to see health care without an exchange (0+ / 0-)

          take a look at the Medicare Advantage and Part D (drug benefit) open season right now.

          Part D is operated entirely by private companies (all insurance companies) in separate regions. They are required to have at least two companies in each region, and some states are have enough population to be a region by themselves. But you either have to pay for the Part D insurance or give up standard Medicare and go to an insurance company for a Medicare Advantage Plan. (These are subsidized at about 10 to 13% higher than regular Medicare costs)

          Each plan negotiates with the pharmaceutical companies on its own and decides how much of the savings to share with the suckers beneficiaries. Each plan also has its own private formulary that determines which medications it will provide.

          This was all set up in the Part D bill Bush and the Republican Congress passed in 2003. It was supposed to prove that competition could provide better health care at lower cost. It has instead proven to provide worse health coverage and require a federal subsidy to even continue to exist. (That's the largest part of the money Obama promises to remove from Medicare costs - the subsidies for inadequate health coverage are a total waste of money both for beneficiaries and for tax payers.)

          If you take a set of specific medications you know nothing about coverage beyond the sales brochures you get in the mail during the open season. This is also true for the physicians! They don't know the insurance coverages either.

          Selecting the coverage that covers your specific set of prescriptions is almost impossible if you take more than 3 or 4 - as most of us seniors do. so how do you choose a plan? You guess!

          Oh, and you are stuck with that plan for the next year. But the plans can change the medication formulary they cover overnight just by notifying you.

          The so-called Free Market does not provide adequate health coverage! All it does is deliver up a set of patients who need coverage to financial predators who make their money by promising health care, charging too much for it, and then by cutting it off if you really need it. All the rules favor the private insurers and they cannot compete on either cost or adequate coverage even then.

          A standardized nation-wide health care market run by the federal government is the only solution! It won't solve all the problems overnight, but it will provide the information everyone in the system - patients, health care providers, administrators, etc. - really need to have to identify and solve the problems.

          The US Supreme Court has by its actions and rhetoric has ceased to be legitimate. Whiskey Tango Foxtrot - over

          by Rick B on Sun Dec 02, 2012 at 08:22:42 AM PST

          [ Parent ]

  •  the good news about these exchanges is that... (12+ / 0-)

    ...time is on our side...eventually, even in the most hard-core anti-Obamacare states, residents are going to realize that everyone else in the rest of the country is benefitting from these exchanges...except them. Eventually, sanity will win over the temporary insanity of these Republican nutjobs.

    •  Everyone will get exchanges. Some on their state (7+ / 0-)

      basis while the rest will have a federal one imposed on them.

      Which I think is just great!

      "I believe more women should carry guns. I believe armed women will make the world a better place. Women need to come to think of themselves not as victims but as dangerous." Anna Pigeon

      by glorificus on Fri Nov 30, 2012 at 09:15:18 PM PST

      [ Parent ]

      •  absolutely... (1+ / 0-)
        Recommended by:

        ...time is on our side in multiple ways on this one...when residents of some of these red states realize that they will have only the federal option available because their states misleaders failed to act on the state level...well...suddenly a lot of these so-called "states rights" Republicans will want to start doing what they should have done to begin with....we have time on our side...

      •  RIGHT !!!! (1+ / 0-)
        Recommended by:

        We know Scott is a no so we will get Federal.   That stupid idiot is so greedy he probably reuses toilet paper twice to wipe his ass.  Stacks it in a corner crap and all.
        Wouldn't surprise me.

        We the People have to make a difference and the Change.....Just do it ! Be part of helping us build a veteran community online. United Veterans of America

        by Vetwife on Sat Dec 01, 2012 at 05:21:27 PM PST

        [ Parent ]

  •  Time is on our side, yes (14+ / 0-)

    But I'm wondering if having a lot of states default to the federal exchange isn't our best path to single-payer, which is what I think our real objective is.  If it creates a rift within the Republican party, all the better!

    -7.75, -8.10; All it takes is security in your own civil rights to make you complacent.

    by Dave in Northridge on Fri Nov 30, 2012 at 03:18:08 PM PST

    •  Any ideas on whether a federal exchange (9+ / 0-)

      covering numerous states, will be able to offer more competitive rates than an exchange run by a single state?

      As a Georgia resident, I would like to see some benefit arise from the state's refusal to set up their own exchange.

      •  There is a benefit. You will fall under the (2+ / 0-)
        Recommended by:
        foresterbob, Rikon Snow

        federal exchange. Do you think Georgia could set up a better exchange than the feds?

        "I believe more women should carry guns. I believe armed women will make the world a better place. Women need to come to think of themselves not as victims but as dangerous." Anna Pigeon

        by glorificus on Fri Nov 30, 2012 at 09:16:31 PM PST

        [ Parent ]

        •  Georgia probably wouldn't (4+ / 0-)
          Recommended by:
          ferg, Mayfly, foresterbob, Dogs are fuzzy

          But Vermont will. They'll use the exchange as a way to stand up their public option.
          Georgia COULD, but given the given...
          The advantage for state setting up their own system is that they a) get money, like $100 million to implement it and b) they have more control over it's structure and rates.
          The advantage to the system as a whole is that states like Vermont and several others will take advantage to innovate and we'll get the benefit of a scaled test of several systems in real time/world. different systems will find different workarounds for problems and successful programs can spread. And the states that would most likely burn their residents, will be served by a federal system, starting, IIRC, in 17 states, That gives time to build a federal system at one third national size, shake the bugs out, et cetera.
          All these knuckledraggers that thought they'd really stick it to Obama by not cooperating, end up with more federal control than if they'd done what they are supposed to.
          And the split here, or several of them, anyway, are the Governors, looking at it closer and clearer than the legislatures. Whether they are wanting to or not, Governors are in a position of having to govern. Legislatures can go term after term without doing a damm ting.
          In the long run, I'd like to see MedicAid be brought into the exchanges as a buy in option for people who are within 500% of the line where MedicAid kicks in. Make it a basic floor that underlies the exchange and make it so that young healthy workers who are not earning much can are included. Their (low) premiums will expand MedicAid's fiscal base and expand it's purchasing power.
          Step by step.....

          If I ran this circus, things would be DIFFERENT!

          by CwV on Sat Dec 01, 2012 at 04:32:33 PM PST

          [ Parent ]

      •  Georgia WTF (6+ / 0-)

        Georgia's plan for health care:

        No to health exchange, but Gov Deal signed into law a bill
        fast-tracking gun permits and hunting licenses for children under 16 if they have a terminal illness.

        "Abandon all hope ye who enter here."

        "What everyone wants is a job and some hope."--RFK

        by For Dean in Dixie on Fri Nov 30, 2012 at 09:46:11 PM PST

        [ Parent ]

    •  I don't think so. Federal exchange is all private (1+ / 0-)
      Recommended by:

      plans, right? There are no government-run plans in the exchanges, so I don't see how it pushes us closer to single payer. Although I did read somewhere that the administration was considering doing something akin to a public option via executive order...have not heard anything about it since though.

      •  it might make changes easier (4+ / 0-)

        For example, the federal exchange could offer a Medicaid plan that the states might block. It's just a little easier to control.

        The executive order thing is basically the Federal employees plan, which is still private but has more indirect Fed control because they're the biggest customer.

      •  It's starts creating a natl standard (2+ / 0-)
        Recommended by:
        ferg, foresterbob

        which probably will become the default, instead of the 50 sets of insurance standards currently in place, that keep insurance companies from competing across state lines.

        I could see that within 10 years most of all health insurance will be purchased thru the federal exchange, making single  payer that much easier to implement.
        Especially, if the big corps like Walmart, wriggle out of paying for their employees insurance, and make medicaid pick up the tab.

        Today's problems are yesterday's solutions. Don Beck

        by Sherri in TX on Sat Dec 01, 2012 at 04:43:54 PM PST

        [ Parent ]

  •  Republican versus Republican versus the Public (4+ / 0-)
    Recommended by:
    chuco35, a2nite, wasatch, Mayfly

    it's really a 3 way fight

    -1.63/ -1.49 "Speaking truth to power" (with snark of course)!

    by dopper0189 on Fri Nov 30, 2012 at 04:14:44 PM PST

  •  It caught my eye (4+ / 0-)

    on the map above that North Carolina is the only Red State shaded in light blue, for "planning for partnership exchange."  Since I live here, I Googled a little and found this on How the Health Care Law is Making a Difference for the People of North Carolina

    The good stuff (links don't work in quote):

    Supporting North Carolina’s work on Affordable Insurance Exchanges

    North Carolina has received $13,396,018 in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges.

    $999,999 in Planning Grants:  This grant provides North Carolina the resources needed to conduct the research and planning necessary to build a better health insurance marketplace and determine how its exchange will be operated and governed. Learn how the funds are being used in North Carolina here.
    $12,396,019 in Exchange Establishment Grants:  These grants are helping States continue their work to implement key provisions of the Affordable Care Act. Learn how the funds are being used in North Carolina here.

    Twelve million bucks?  Go girl!  Gov. Perdue and her team have done a great job on this, and hopefully will get more credit as more of the law takes effect.  It will be highly interesting to see how the Exchanges roll out in a red state with a GOP Governor and legislature.  I'm giving Gov-Elect McCrory the benefit of the doubt for now.

     I can think of no more stirring symbol of man's humanity to man than a fire engine.     -- Kurt Vonnegut

    by SteelerGrrl on Fri Nov 30, 2012 at 04:39:11 PM PST

  •  What's wrong with these people? (4+ / 0-)

    People need health care and these politicians who opposed the ACA are willing to gamble with people's lives because of politics? Taking care of people makes more economic sense than allowing them to show up very sick at the emergency room.

  •  Yep. (0+ / 0-)

    "I believe more women should carry guns. I believe armed women will make the world a better place. Women need to come to think of themselves not as victims but as dangerous." Anna Pigeon

    by glorificus on Fri Nov 30, 2012 at 09:17:21 PM PST

  •  What seems ironic (4+ / 0-)
    Recommended by:
    citizenx, Odysseus, Mayfly, foresterbob

    is that the Republicans for the most part are so anti-government and pro states' rights, and yet the majority of the red states are defaulting to having the federal government run their program. I'm sure it's all just their version of a temper tantrum, but still, their action flies in the face of everything they normally stand for--they are giving over control of part of their state's activities to the Democratic federal government, hence the irony. And meanwhile, most of the blue states are setting up their own exchanges.

    •  They'd rather play blame game (4+ / 0-)
      Recommended by:
      CwV, Mayfly, foresterbob, chantedor

      I suspect the plan (if there is one) is to keep their own fingerprints off the ACA, so when people get angry about the individual mandate and the employer mandate, they can blame it all on that mean socialist terrorist Federal government and show how hard they tried to stop it and prevent it being implemented.

      We're assuming that once the law gets fully implemented, most people will be thrilled and give credit to whoever implemented it.

      If that happens, it won't take more than 3 seconds for the GOP obstructors to claim the credit, just as they did for the stimulus package they voted against.

    •  Double irony (1+ / 0-)
      Recommended by:

      Their stated position was that the private sector could compete to offer good health insurance, and that free markets are good.

      An exchange is a market, full of private sector companies competing to offer health insurance.

      It's like offering 2-year-olds things they said they wanted and hearing them scream "NO! NO! NO! NO!".

  •  So all the States Rights, 10th Amendment states (6+ / 0-)

    are deferring to the Federal Gvt. to do this for them?

  •  Michigan's Governor is a corporatist. (1+ / 0-)
    Recommended by:

    State House and Senate are Teabagger!   Together, there isn't anything they can screw up.   That's why MI is planning instead of refusing.   I'm sure we'll get something better from the Feds than anything the state would do.  

    If money is speech, then speech must be money.

    by dkmich on Sat Dec 01, 2012 at 04:09:06 PM PST

  •  This is so much fun! (2+ / 0-)
    Recommended by:
    annan, foresterbob

    We give them the right to do it themselves, and when they refuse, we do it for them.  Which is totally a violation of their rights!

    But in the end, more folks like me might be able to afford coverage.  Especially if that "stealth public option" actually comes to pass.

    Early to rise and early to bed Makes a man healthy, wealthy, and dead. --Not Benjamin Franklin

    by Boundegar on Sat Dec 01, 2012 at 04:10:59 PM PST

  •  Will they televise it?! (0+ / 0-)

    The fight would be worth watching!

    And on a serious note, since the outcome means a lot to the poor people, I hope the good Republicans win.

    ("good Republicans" - never ever thought I would utter that phrase...)

    (-7.75,-5.64) Headline: "Man who told half the nation to go screw themselves somehow loses a national election".

    by Whirlaway on Sat Dec 01, 2012 at 04:14:59 PM PST

  •  Here in AZ, our governor Brewer wants all the (2+ / 0-)
    Recommended by:
    citizenx, foresterbob

    $$$ she can wring out of the federal gov, she just doesn't want them looking over her shoulder to see where, or in some cases, to whom, it's going.  

  •  Partnership Exchange? (2+ / 0-)
    Recommended by:
    ferg, foresterbob

    What's that mean?  Maybe this helps from

    The Partnership model describes Exchanges where both HHS and a state work together to operate different functions of the Exchange. The goal of the Partnership is to take advantage of the state’s expertise and knowledge of their insurance markets to support a seamless consumer experience. States may use Exchange grant funding to support the functions they choose to operate under the Partnership that are related to establishing the Exchange.

    "In the end, we will remember not the words of our enemies but the silence of our friends" -Martin Luther King Jr

    by blue denim on Sat Dec 01, 2012 at 04:15:24 PM PST

  •  Map's out of date... (2+ / 0-)
    Recommended by:
    citizenx, foresterbob

    Arizona under our pathetic finger-wagging excuse for a governor has opted to let the feds do it.

    Just another faggity fag socialist fuckstick homosinner!

    by Ian S on Sat Dec 01, 2012 at 04:16:18 PM PST

  •  Does Anybody Know if All the Participants in All (2+ / 0-)
    Recommended by:
    Odysseus, foresterbob

    the federally administered programs in numerous states will all constitute one single risk and purchasing pool?

    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 Sat Dec 01, 2012 at 04:16:27 PM PST

    •  I don't think so. (0+ / 0-)

      Although I'm not really certain.  I believe the Feds will set up a unique exchange in each state which would sell insurance regulated by each state's laws.

      (I think states do have the option of making a compact with neighboring states and using one exchange, but it doesn't appear that any of them are doing so)

  •  Arizona blew off the state exchange option. (3+ / 0-)
    Recommended by:
    citizenx, Alan Arizona, foresterbob

    Our dear governor, Jan of the Scorpions, refused the state-run option in the last few days. Too much money, she said, and no promise it will work either.

    IIRC, the feds were going to give grants to pay for the state exchanges to be set up? She probably blew the deadline for the grant, thus her "I meant to do that" moment.

    I can't wait for 2014 to get here.

  •  I'm in TN and wondering if the federal exchange (3+ / 0-)
    Recommended by:
    Sherri in TX, citizenx, foresterbob

    would be better than the state exchange. I have Medicare so it does not affect me, but my husband has 10 more years of private individual insurance. I kind of think the federal program might be better for him and others than what the state sets up. Does anyone know for sure?

    You can't scare me, I'm sticking to the Union - Woody Guthrie

    by sewaneepat on Sat Dec 01, 2012 at 04:22:28 PM PST

    •  You can't possibly know for sure since it's (1+ / 0-)
      Recommended by:

      a hypothetical.

      If TN sets it up themselves we won't know what the Federal program in TN would have looked like, and if the Feds set it up in TN we won't know what the TN would have looked like . So how can we say which one would have been better?

      But my guess is a Fed setup in a state is going to be better than a state setup in a state which is highly anti-Obamacare.

      •  Would the federal program not be the same for (0+ / 0-)

        all states? I tend to agree with your guess that the Federal program would be better. It would be nice if all states also had the federal option.

        You can't scare me, I'm sticking to the Union - Woody Guthrie

        by sewaneepat on Sun Dec 02, 2012 at 03:09:19 AM PST

        [ Parent ]

    •  cowering in TN (1+ / 0-)
      Recommended by:

      When Bredesen was governor, the Dept. of Commerce and Insurance worked very aggressively to prepare implementation of the ACA and state exchanges.  (I have friends who worked in that Dept. and that's what they did, along with their coworkers.  They pushed ACA implementation as far and as fast as they could before the new administration came in.)

      So it's not like Haslam has to start from scratch; a good bit of the work has been done. He just has to finish it.

      But while Haslam is not tea-partyish himself, he must kiss the ring of the Dark Lord from NASCAR-land, and the Dark Lord wields power ruthlessly and is wingnutty as he can be. Also, the teabaggers are pretty strong in the state GOP and the legislature.  

      Haslam hates to fight--and the legislature would love to fight Obamacare. Meanwhile Tennesseans do without healthcare.

      It's infuriating...Haslam has no excuse for not going forward with ACA, much of the work is done already, and he knows we have a huge uninsured population and Tenncare is inadequate. But he's not a brave guy.

      •  It is infuriating, however, I don't trust (0+ / 0-)

        Bredesen that much after the way he handled his dismantling of the TennCare uninsurables program. But I will trust your friends and their co-workers that they put together a good program. We will see what happens.

        You can't scare me, I'm sticking to the Union - Woody Guthrie

        by sewaneepat on Sun Dec 02, 2012 at 03:07:38 AM PST

        [ Parent ]

  •  They will have to be (2+ / 0-)
    Recommended by:
    wyvern, foresterbob

    dragged kicking and screaming into the 21st century.

    "A lie is not the other side of a story; it's just a lie."

    by happy camper on Sat Dec 01, 2012 at 04:22:44 PM PST

  •  Iowa? (4+ / 0-)

    Did something change? Last I heard, our Governor was whining.

    •  Yes, he's whining. (0+ / 0-)

      Gov. Branstad did say that the state would have a state-level exchange, but he wants answers to some questions before he can submit any detailed plans. He also responded to the extended deadline.

      His communication director said,

      “Make no mistake, this deadline was extended because the federal government does not have the answers or capability to administer the Obamacare program,” said Albrecht. “This deadline was not pushed back to give the governors more time, rather it was a lifeline to help save themselves.”
      Branstad sent a letter to HHS Secy Sebelius with 50 questions.
  •  I Just Don't Get It. (2+ / 0-)
    Recommended by:
    citizenx, foresterbob

    Why do all these states-rights GOP governors want the Feds to control their exchanges with no input from the state when they could make their own? This just proves that the GOP only cares about inflicting petty revenge over the fact that the people support what they spent four years bitching and moaning over.

    •  From what I can tell from the article.... (0+ / 0-)

      The GOP is holding out hope and crossing their fingers that the law's policies will completely fail and be subsequently repealed. Not supporting the law's enactment will increase the chances of it's failure.

       The chance they're taking is the law could prove very popular and they could lose support in the upcoming elections.

       Break out the popcorn!

  •  Does anyone know the states with (0+ / 0-)

    State based exchanges (blue) will they improve?.  I know someone in New York and their exchanges are not very affordable for this single mom and two children.

    Do not adjust your mind, there is a flaw in reality.

    by Shrew in Shrewsbury on Sat Dec 01, 2012 at 04:56:05 PM PST

    •  Your costs will go down, that's almost certain. (0+ / 0-)

      (You will almost certainly be eligible for federal subsidies, if nothing else)

    •  I worry about the price too. As of now, my (0+ / 0-)

      husband insurance covers all of us and is almost free.  We pay about 100 per pay period and it is good insurance. BUT, they are threatening to drop it....not understanding why, but it is being rumored.

      I did the the calculator for our income and family size and we would pay close to 750 per month! It says for a family of 4 but we are a family of 5 and so I'm not sure how that will be increased. I also have a son with medical conditions and I'm not certain if the rate would increase further because of that. Regardless, almost 800 per month would break us...we would likely just pay the fine and do without or get it just for the kids.

  •  Obviously Democrats need to compromise (1+ / 0-)
    Recommended by:

    wait... what? :)

    "Do what you can with what you have where you are." - Teddy Roosevelt

    by Andrew C White on Sat Dec 01, 2012 at 05:11:27 PM PST

  •  North Carolina (2+ / 0-)
    Recommended by:
    Mayfly, foresterbob

    Lame Duck Gov. Bev Perdue (D) made the decision to go with a state-federal partnership.  I don't know where exactly Gov-Elect Pat McCrory (R) stands on the issue.  Could he change her decision?

    The Insurance Commissioner, Wayne Goodwin (D), was re-elected this year.  So how much say will he have on the issue?

  •  while here in the Commonwealth of Massachusetts (2+ / 0-)
    Recommended by:
    foresterbob, cocinero

    an email went out to all the employees of one of my client companies (and I do NOT do HR/Benefits, I do technical consulting) .. a medium-sized company (about 1000 employees)

    The email said:

    "Coverages and costs will be flat for 2013; there will be no change in coverages or deductibles, and there will be no change in employee costs."

    So, well, yeah. All this stuff CAN work. At least when people take their heads out of their political rectum.

  •  I wonder how long "Obamacare" will persist. (0+ / 0-)

    The term, i mean.  Will it ever fade and be replaced with Affordable Care Act?

    I'm gong to guess not because when it's all running people will be disappointed at how not affordable it all still is, and they will want to blame someone.

  •  NO. It's republican versus citizen. (0+ / 0-)

    Do not be overcome by evil but overcome evil with good. ~ Romans 12:21

    by Mickquinas on Sat Dec 01, 2012 at 05:33:27 PM PST

  •  I read... (0+ / 0-)

    ..the Politico article.

    Mississippi Insurance Commissioner Mike Chaney is having to deal with a governor (MS governor Phil Bryant) who is so immersed in right wing conspiracy theories, he (Phil Bryant) sounds like a raving lunatic when he even discusses the ACA with Chaney.

    These Republican governors are so full of Rush Limabugh & Fixed News bullshit, they are incapable of making rational decisions.  


    "You just gotta keep on livin man! L-I-V-I-N!" - Wooderson

    by wyvern on Sat Dec 01, 2012 at 05:33:45 PM PST

  •  Question (0+ / 0-)

    Don't want to sound like a dufus, but here goes...

    Doesn't a state relinquishing to the federal exchange hasten the move to single payer health care?  (Or Gasp!, Socialized medicine)

    If not, Why not?  

    I'm just not conversant with the finer points of the ACA.  

    Thanks in advance.

    ... the watchword of true patriotism: "Our country - when right to be kept right; when wrong to be put right." - Carl Schurz; Oct. 17, 1899

    by NevDem on Sat Dec 01, 2012 at 05:34:40 PM PST

    •  In some states Yes, in some states NO (0+ / 0-)

      In the doofus states having a Federal exchange is probably preferable during what we hope is an intermediate period.  In states like Hawaii, California, or Washington where the exchange will be effective as the state already had a state system this will work for the shorter term just fine and the state systems will integrate with single payer when that comes along.  What's the difference?--it's the competence, organization, and motivation of the states in question.  Most of the blue states setting up their own systems are motivated to make this work and at the best cost.

      "It's too LATE to stop now!" - John Lee Hooker

      by Rolfyboy6 on Sat Dec 01, 2012 at 06:14:47 PM PST

      [ Parent ]

  •  "Insurance commissioner" (1+ / 0-)
    Recommended by:

    may not be as sexy as "governor" or "president", but this goes to show how important it is to support progressives (and competent people, period) up and down the ballot.

  •  I wonder about the messaging in the '14 Midterms.. (1+ / 0-)
    Recommended by:

     There are some fairly Democratic states that elected GOTP state governments in 2010 (Looking at ME, NH, PA, NJ, WI, and to a lesser extent FL and VA). I look forward to looking at the State exchange in OCT 13 and knowing I'll never be beholden to an employer for health coverage. If it does an increase in democratic support in those 7 states?

     In my opinion, Democrats really failed to state the benefits of ACA in the 2010 campaigns. Let's hope the opposite is true this time.

  •  "Idaho's legislature is kind of crazy" (0+ / 0-)

    A candid assessment by an Idahoan.

  •  Let me get this straight. (0+ / 0-)

    These morons say they don't want the Federal government to dictate health policy.  In order to prevent this they are telling the Federal government to go ahead and dictate health policy.  The exchanges being setup by the states was included in the ACA at the specific request of Republican governors.  Now they make a big show of turning up their noses at the opportunity.  Tell me again how these fools haven't been driven to madness by their pathetic ideology.

    You have the right to remain silent. If you waive that right you will be accused of class warfare.

    by spritegeezer on Sat Dec 01, 2012 at 08:36:07 PM PST

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