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Obama's signature on Affordable Care Act
The Department of Health and Human Services gave states an extra month to make the final decision on whether or not they would set up health exchanges themselves under the provisions of the Affordable Care Act, or have their states participate in the federal exchange. The initial date was too soon for many governors, who were holding out hope for a Romney win and repeal of Obamacare, hence this extension. The last of the decisions are trickling in.

Gov. Butch Otter in Idaho has chosen to set up the exchange, following the recommendation of a bipartisan panel he created to advise him on that. He was as wing-nutty conservative as he could be in announcing his decision:

"There will be a health insurance exchange in Idaho," Otter said in a statement. "Our options have come down to this: Do nothing and be at the federal government's mercy in how that exchange is designed and run, or take a seat at the table and play the cards we've been dealt. I cannot willingly surrender a role for Idaho."
but he's doing it.

On the other hand, Pennsylvania's Republican Gov. Tom Corbett is not, missing the boat on the great wing-nutty opportunity to talk about avoiding the "federal government's boot on our throats" rhetoric so deftly deployed by Otter.

"Health care reform is too important to be achieved through haphazard planning," Corbett said, according to the Associated Press. "Pennsylvania taxpayers and businesses deserve more. They deserve informed decision making and a strong plan that responsibly uses taxpayer dollars."
Whatever, governor. Likewise, Tennessee's Gov. Bill Haslam will leave it up to the feds, using basically the same rhetoric as Corbett about uncertainty.

Another hold-out is Utah, which is in a slightly different circumstance. The state already has an insurance exchange, and is trying to get it grandfathered in to the law. It's not likely to happen without significant changes in the existing exchange, says Jennifer Tolbert, director of state health reform at the nonpartisan Kaiser Family Foundation.

First, Utah’s plan is not designed to offer health insurance to individuals as required in the federal law. Secondly, Utah’s is not structured to distribute federal tax credits aimed at low income people who are uninsured. Utah plans to open up the plan to individuals in the future.
Finally, in related news, Nevada's Republican Gov. Brian Sandoval announced his state would take the Medicaid expansion money offered to states under Obamacare. Nevada agreed to set up its exchange two years ago, so that's no longer an issue. Since the Supreme Court ruled that states could opt out of the expansion, nine states have declined the expansion, so far. There's potentially room for them to revise that decision when they realize the scope of what they're missing out on. There is no firm deadline for a decision on Medicaid expansion.

Originally posted to Joan McCarter on Wed Dec 12, 2012 at 03:48 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  I went to look up my state (8+ / 0-)

    (Gov. Martinez previously vetoed an exchange for NM but has changed her tune) and found that Kaiser is publishing detailed profiles on the status of emerging health insurance exchanges, state by state:

    Kaiser: State Health Exchange Profiles

    "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

    by lgmcp on Wed Dec 12, 2012 at 04:09:46 PM PST

  •  I suspect that we citizens of Louisiana... (12+ / 0-)

    ...would benefit more from a federally-operated exchange than we would benefit from an exchange set up in-state by ideologues like Jindal, his creatures and his sponsors.

    So, yeah, Jindal, stay out of it.

    Cheers.

    •  Except that Jindal will bail out of Medicaid (5+ / 0-)

      expansion along the way, and continue to keep many of your fellow residents in misery.

      “I’m able to fly, do what I want, essentially. I guess that’s what freedom is — no limits.” Marybeth Onyeukwu -- Brooklyn DREAMer.

      by chuco35 on Wed Dec 12, 2012 at 04:46:37 PM PST

      [ Parent ]

      •  seems likely that providers will pressure 'im... (3+ / 0-)
        Recommended by:
        blue aardvark, CwV, ColoTim

        ...'cause of the potential income, and providers are some of his sponsors.

        Tho' time will tell on that...

        Cheers.

      •  Essentially (2+ / 0-)
        Recommended by:
        luckydog, HeyMikey

        if the states choose not to participate, the federal government has the option to extend the medicaid participation, but they must cover 100% of the cost vs 90% if the states run it.

        95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

        by PRRedlin on Thu Dec 13, 2012 at 06:12:25 AM PST

        [ Parent ]

      •  What about future guvs? (2+ / 0-)
        Recommended by:
        luckydog, HeyMikey

        This brings up a question I have, living in PA where it doesn't appear that our incompetent dimwit governor will accept the Medicaid expansion either(or did he already reject it?  I'm sure he will).
        Does Obamacare allow for future state governors to opt-in to the Medicaid expansion at any later date?  I think that's important because it's going to become pretty obvious in a short time to residents of states with these idiot governors how much worse off they are than those who took the Medicaid expansion.  
        I don't think the residents of those states should be punished.  

        •  While there is a time limit for opting into (2+ / 0-)
          Recommended by:
          luckydog, HeyMikey

          the insurance exchange system, or let the feds do it for you, there is no time limit for deciding to take more federal Medicaid funds -- so long as you're willing to kick in the 10% that the law requires.

          Hopefully the benefits of ACA are clear enough by 11/14 to affect the midterms, as it cranks up on 1/14.

          “I’m able to fly, do what I want, essentially. I guess that’s what freedom is — no limits.” Marybeth Onyeukwu -- Brooklyn DREAMer.

          by chuco35 on Thu Dec 13, 2012 at 08:37:29 AM PST

          [ Parent ]

  •  At what point do states start to lose federal (4+ / 0-)

    money if they don't sign up for Medicaid expansion? Put another way, at what point do states who are in agreement start to see extra federal Medicaid money under ACA to expand coverage for their residents?

    “I’m able to fly, do what I want, essentially. I guess that’s what freedom is — no limits.” Marybeth Onyeukwu -- Brooklyn DREAMer.

    by chuco35 on Wed Dec 12, 2012 at 04:44:29 PM PST

    •  Existing medicaid funding is not affected (6+ / 0-)

      but additional medicaid funding would be lost.  however, for additional the federal government would pay 90%, and the state 10%.  So by not setting up or allowing the additional medicaid, these states ARE saving 10% of the cost that they would otherwise have to pay.

      It's a sweet deal, but technically it is an increase.  Compasisonate governors would gladly spend 10% to get 90%, but most R's are not compassionate.

      95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

      by PRRedlin on Thu Dec 13, 2012 at 06:10:44 AM PST

      [ Parent ]

      •  When do they start to get the 90%? nt (0+ / 0-)

        “I’m able to fly, do what I want, essentially. I guess that’s what freedom is — no limits.” Marybeth Onyeukwu -- Brooklyn DREAMer.

        by chuco35 on Thu Dec 13, 2012 at 07:32:33 AM PST

        [ Parent ]

        •  2014 (3+ / 0-)
          Recommended by:
          chuco35, HeyMikey, harrije

          is when these exchanges need to be going full force, and i beleive that the medicaid is connected to that.

          This was actually postponed this long from Pelosi.  They needed a way to show that the ACA reduced costs over a 10 year period, so starting in 2009, to 2014 (5 year period) was counting to 2019.  Truth is THIS portion will cost money, but other portions will save money.  They needed to build up the other provisions first to reduce medicaid expenses, in order to pay for this to make it revenue neutral.

          Otherwise, republicans would have been right in saying that the ACA raised costs.

          95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

          by PRRedlin on Thu Dec 13, 2012 at 07:41:43 AM PST

          [ Parent ]

          •  What's Medicaid-exchange connection? (0+ / 0-)
            2014 is when these exchanges need to be going full force, and i beleive that the medicaid is connected to that.
            I was thinking they were separate. Do you have more info?

            "The true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals." - Barack Obama

            by HeyMikey on Thu Dec 13, 2012 at 09:03:16 AM PST

            [ Parent ]

            •  no they are separate (0+ / 0-)

              but from my memory of reading everything, all things are connected to that date to begin.

              there are not medicaid exchanges, i was simply stating that's when they both go into effect.

              95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

              by PRRedlin on Thu Dec 13, 2012 at 09:32:17 AM PST

              [ Parent ]

    •  In the LVRJ this morning... (1+ / 0-)
      Recommended by:
      harrije

      ...there was an article about Sandoval accepting the Medicaid expansion and he put it in simple terms.  It would cost $86 billion to refuse, and $68 billion to accept.

      Here we go again.  Simple arithmetic.

      So simple even a Republican governor gets it.

  •  In AZ, Jan Brewer is so upset about oversized (7+ / 0-)

    federal gubmint that she is letting them work out our state exchange. SIGH
    She is also leaking a rumor that she will run for a third term in 2014. Can't stand her, but hey maybe she'll run for POTUS in 2016 and give us some comedic soundbites.

    Romney = Nixon without the sweating problem

    by YoungArizonaLiberal on Wed Dec 12, 2012 at 05:29:09 PM PST

  •  Fight the expansion of Federal power (7+ / 0-)

    by letting the Federal Government run our state's insurance exchanges!

    It makes sense, I guess, if you think Glenn Beck is a scholar.

    Economics is a social *science*. Can we base future economic decisions on math?

    by blue aardvark on Thu Dec 13, 2012 at 06:05:32 AM PST

  •  AS I'VE SAID BEFORE (8+ / 0-)

    It really does not matter whether they set up the exchange or not, other than NOT setting up an exchange will lead to Single Payer FASTER.

    Under both the federal and the state guidelines, there MUST be a non-profit option.

    Non-profit option will ALWAYS be cheaper.  So the more states that choose a federal option, will collectively pool all people towards a federal NON-profit option, i.e. Single Payer.

    Even states that choose to set up their own, must still offer a non-profit option, however it will still be more expensive than a federal non-profit (less participants means higher premiums vs federal).

    I wish Democratic governors were the ones refusing to set this up.  Hell I wish ALL 50 governors would refuse to set up an exchange.  Then we'd have single payer even faster.

    95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

    by PRRedlin on Thu Dec 13, 2012 at 06:08:58 AM PST

    •  Where does that non-profit option come from? (0+ / 0-)

      Is that MedicAid? Or is it a new rig?

      If I ran this circus, things would be DIFFERENT!

      by CwV on Thu Dec 13, 2012 at 06:26:52 AM PST

      [ Parent ]

      •  Either the states or the feds (3+ / 0-)

        must set up "exchange" from which people can purchase insurance.

        Within these exchanges, one option of insurance providers MUST be non-profit.  i.e. insurance company A, insurance company B, non-profit entity C.

        Non profits are always cheaper.  In order to compete, private insurance companies will need to cut benefits.

        So any idiot with half a brain would chooes the non-profit as it will either 1. be cheaper, or 2. offer more services for the same price.

        Republicans hate to offer anything for free, (or would be shunned to offer this against their friends at the insurance companies and compete with them) so they are washing their hands of the deal.

        The result is, over time, say 10-15 years, insurance companies will take a huge hit as more and more people migrate to the federal non-profit, resulting in (for most smart people) single payer.

        95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

        by PRRedlin on Thu Dec 13, 2012 at 06:33:33 AM PST

        [ Parent ]

        •  Ok, but the non profit could be the one that (0+ / 0-)

          offers less, because it's non profit.

           In other words, the for profit could offer you more, if you are willing to pay for it.  Just because it is non profit, does not mean it will offer more, in actuality, it stands to reason, it will offer less.

          •  All plans under the law (2+ / 0-)
            Recommended by:
            gof, HeyMikey

            must offer specific things.

            So all plans will offer a core of things, such as major medical, office visits, prescription plans, etc etc at the same rates of pay.

            In theory, yes the other plans can offer more, but on a dollar for dollar basis, the core options will be cheaper under the non-profit.

            Honestly the way I see this all turning out is this:

            Single payer for basic and catastrophic coverage.  Regular day to day things.

            And private insurance for optional stuff.  Kind of like how you can get car insurance for basic coverage, and then you can buy additional coverage from another company for "unexpected repairs" not related to accidents.

            The vast majority of people however, just get basic coverage, because when it comes down too it, they just want to make sure they are safe in the event of an emergency.

            95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

            by PRRedlin on Thu Dec 13, 2012 at 07:25:59 AM PST

            [ Parent ]

          •  it is also important to mention (1+ / 0-)
            Recommended by:
            HeyMikey

            that under the ACA (obamacare)  vision and dental are not part of it, so these companies will still operate in those fields.

            95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

            by PRRedlin on Thu Dec 13, 2012 at 07:26:50 AM PST

            [ Parent ]

          •  You argue like a Republican (0+ / 0-)

            "It stands to reason" regardless of any facts.

            Non-profits do not pay out profits, by definition. So they can put more of the premiums they receive into benefits. So you would have to be an idiot or an ideologue not to get your insurance from them.

            America—We built that!

            by Mokurai on Thu Dec 13, 2012 at 09:36:36 AM PST

            [ Parent ]

            •  ^ this is my reasoning (0+ / 0-)

              95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

              by PRRedlin on Thu Dec 13, 2012 at 09:39:25 AM PST

              [ Parent ]

            •  Yeah, ok.....no the fact of the exchange would be (0+ / 0-)

              a public option that would be the minimum and of course the for profit would attempt to get you as a customer by offering more, if you wish to pay that higher amount.

              The non profit has a budget as well, and would have limited grants, funds etc to provide whatever the exchange mandates.

    •  Follow up questions. (0+ / 0-)

      I thought the point of the exchange was to allow insurers to compete for the "pool?" But what is no insurers/payers step up? Can the government set up a (gasp) public option?

      •  They'll step up. (0+ / 0-)

        It's tens of millions of potential customers. Somebody will want to tap that market.

        "The true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals." - Barack Obama

        by HeyMikey on Thu Dec 13, 2012 at 09:13:34 AM PST

        [ Parent ]

      •  contained in the aca (0+ / 0-)

        is a provision that AT LEAST ONE option is non-profit.  If no private insurances step up to join, automatic single payer.

        95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

        by PRRedlin on Thu Dec 13, 2012 at 09:35:52 AM PST

        [ Parent ]

      •  This is why, in an interview long ago (0+ / 0-)

        Obama said "we'll get to single payer, it may take 10 or 15 years, but we'll get there"

        and the D's snuck this provision in for the non-profit.  

        Technically it's private single payer, but non-profit is non-profit, whether it's government or charitable.

        95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

        by PRRedlin on Thu Dec 13, 2012 at 09:37:27 AM PST

        [ Parent ]

  •  Man, do I feel dumb... (0+ / 0-)

    ...is the position of, say, Gov. Otter of Idaho ANTI Obamacare? It's very confusing to this oldster.

  •  Indeed, (6+ / 0-)
    "Health care reform is too important to be achieved through haphazard planning," Corbett said,
    which i what happens when you piss away 2 years hoping for one of the multiple pathological liars to take the White House and more nutbaggers to take the Senate.  

    Here's hoping Corbett is a one termer.

    " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

    by gchaucer2 on Thu Dec 13, 2012 at 06:16:37 AM PST

  •  I see Floriduh (5+ / 0-)

    is undecided and Governor Skeletor has requested more info so they can come to an agreement of some sort. I'm guessing that means some kind of deal where his companies get preferential treatment of some sort. Fucking thief.

    ~War is Peace~Freedom is Slavery~Ignorance is Strength~ George Orwell "1984"

    by Kristina40 on Thu Dec 13, 2012 at 06:25:40 AM PST

  •  Is Federal plan really a bad idea? (3+ / 0-)
    Recommended by:
    ColoTim, Vote4Obamain2012, HeyMikey

    I have to say, the state-by-state implementation of the ACA looks like a nightmare, creating an additional layer of inconsistency (and therefore complexity) on top of that created by using multiple private insurance carriers instead of single-payer. I understand it was essential to getting the bill through Congress, but it's an insane way to run things.

    It means my options depend on which side of the state line I live on, and medical providers who draw from multiple states (as many do) will still have to deal with multiple versions of every insurance plan, and employers with multiple locations may have a different set of options for each one.

    And it means that underfunded state officials, some of whom were hired for their political connections rather than their technical expertise, are each having to reinvent the wheel, with all the opportunities for incompetence and corruption.

    It seems to me that having the Feds in charge of designing the options for half the states is progress, and when combined with Medicaid expansion and Medicare, and the option for people to join the Federal employees' plan (if that's really happening) has the potential to create, over time, a de facto single payer system.

    So we may yet end up grateful to the pols who chose not to set up a separate state exchange.

    •  My hope is the Federal plan is well enough (1+ / 0-)
      Recommended by:
      HeyMikey

      designed that state exchanges use many of the same guidelines.  Fortunately, I believe the Feds have to approve the state plans to make sure they cover the various requirements and so it's not solely going to be the option for the states to screw their residents.  If that were the case, I have a feeling many Republican governors would set up an "exchange" where people would still be left out.  Instead, I think there are enough requirements for the states that even when they're doing it themselves, they'll still be fairly similar.

    •  I have the same question: Federal downside? (0+ / 0-)

      F'rinstance, I live in Georgia, where our Gov. Deal is a panderer to the Tea Party and a crook with a proven track record of appointing his cronies to government jobs. If Georgia were to set up its own exchange, it would probably be badly run, screw the public at every opportunity, and make more of Deal's cronies rich.

      If there's a downside to the feds running a state exchange, I don't know of it.

      "The true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals." - Barack Obama

      by HeyMikey on Thu Dec 13, 2012 at 09:16:42 AM PST

      [ Parent ]

  •  Corbett restated: "We blew it with our bet on (3+ / 0-)

    Romney to win.  It's too late for the state to build anything good enough.  We just hope that the Feds can do better."  The TN governor is saying the same thing.

  •  Rick Scott has been silent (1+ / 0-)
    Recommended by:
    Vote4Obamain2012

    after raging against Obamacare for freaking ever. I'm assuming he is going to set up a state plan or a partnered plan w/ the feds.  I think he would have already opted for the feds running the plan if that was the route he wanted to take.  

    It's not easy being a Floridian: PS I'm a lawYER now; no longer a lawSTUDENT.

    by lawstudent922 on Thu Dec 13, 2012 at 06:34:17 AM PST

  •  Something is odd in the last paragraph. It starts (2+ / 0-)
    Recommended by:
    dufffbeer, The Baptist Death Ray

    with Sandoval, then jumps to "nine states".....  Looks like something got edited out accidentally.  Sandoval apparently acted somewhat rationally (per Charlie Pierce), which would be news for a repub governor.

  •  Sherman Anti-Trust (0+ / 0-)

    If the Sherman Anti-Trust Law exempts Insurance companies from competition, how does a State set up an exchange where Insurance companies will compete?  Twenty-two States have opted out, while 18 have decided to proceed.  There are only ten more that haven't announced plans.  
    It's beginning to look like single-payer, universal health care is going to be the best option, and that would save people the most money.  The US spends more than $7,000 per person per year, which is double what other industralized nations spend.  Universal Single-Payer would bring the US in line with other countries.
    Maybe, after the Republicans finish their hissy fits, we can settle down and get to business.

    •  that's the crutch (0+ / 0-)

      the states that have opted in

      will basically provide the following options:

      Existing insurance companies vs state controlled non-profit (state level single payer).

      The states taht have opted out, will be as follows:

      Federally selected insurance companies vs federally controlled non-profit (national single payer).

      So in essence, the R's are doing single payer a huge favor.

      95% of all life forms that once existed on earth are now extinct. It is only a matter of time until the Republicans follow suit.

      by PRRedlin on Thu Dec 13, 2012 at 07:31:18 AM PST

      [ Parent ]

  •  Joan, I think there's a gap in the first sentence (0+ / 0-)

    ... of your last paragraph:

    Finally, in related news, Nevada's Republican Gov. Brian Sandoval nine states have declined the expansion, so far.
    The news, I believe, is that Gov. Sandoval opted in.

    "The smartest man in the room is not always right." -Richard Holbrooke

    by Demi Moaned on Thu Dec 13, 2012 at 07:25:57 AM PST

  •  As a Tennessean, I'm glad (0+ / 0-)

    I mean, really, given the choice between having the federal government run healthcare here and having the idiots in downtown Nashville run it, it's a win-win.

    And the bright side of the downward thermodynamic spiral is, um...

    by eodell on Thu Dec 13, 2012 at 07:26:40 AM PST

    •  I spent a summer in Nashville once (0+ / 0-)

      in Peace Corps training. (The only Koreans they could get to teach us on short notice were at a bible college there.) One of our exercises in cross-cultural exploration was to go out around town and see what we could make of city and state politics.

      This was back in 1966, when Nashville had just expanded to metro rather than city government in order to dilute the Black vote, and when the sheriff had said of an inmate who died in prison, "Damned dead N * * * * * ain't worth but $10,000," and was astounded to find that that meant he couldn't run again.

      After learning at City Hall the approved way to fix a traffic ticket, I went into the Black YMCA (as a huge sign proclaimed) on the next block over to inquire whether that was still true. The manager said that it wasn't, but he hadn't gotten around to changing the sign. Then he told me about the Civil Rights legal cases in the 1930s that he had been involved in.

      There was more about kingmakers, leapfrog governors, dry counties where the bootleggers voted with the churches, playing Tennessee tear-jerkers on my banjo, and on and on. All very educational, though in no way a real preparation for living under a military semi-dictatorship with North Koreans coming over the border to try to kill President Park Chunghee, and actually killing a friend of my best friend. Well, the Evangelicals were much the same, as we had seen with the bible college students.

      America—We built that!

      by Mokurai on Thu Dec 13, 2012 at 09:56:15 AM PST

      [ Parent ]

  •  This kills me (1+ / 0-)
    Recommended by:
    michaeloberg

    "Health care reform is too important to be achieved through haphazard planning," Corbett said.  What a joke.

    The whole idea of the four-year time period for the ACA to kick in was that, with all that time, planning wouldn't be haphazard.  There would be plenty of time to do it right.  Instead, these guys dragged their feet and ignored their responsibilities to their constituents in hopes of overturning the thing.  Now they're playing catch-up.

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