Wayne Greene: State faces health exchange deadline
BY WAYNE GREENE World Senior Writer
Sunday, March 04, 2012
3/04/12 at 9:25 AM
Gov. Mary Fallin says she doesn't want a federal health-insurance exchange imposed on the state.
"The governor wants to avoid, at all costs, a federal Obama-care exchange being forced on the state of Oklahoma," Fallin spokesman Alex Weintz said in an email Friday.
"Under current law, the federal government will impose an Obamacare exchange on Oklahoma by January 2013 if the state does not act. While Governor Fallin envisions a marketplace governed by free-market principles and consumer choice, President Obama does not. For that reason alone, it is far preferable for the state of Oklahoma to design and create its own marketplace."
Weintz is right about the looming deadline. The federal Affordable Care Act says all 50 states must have a plan for a health-insurance exchange in place by the beginning of next year. The exchange has to be ready to start enrolling people by October 2013 and have them fully covered by Jan. 1, 2014.
Any state that falls short of the mark gets a federal exchange.
The nagging question is: Is the exchange the state is preparing to present to the federal government good enough to prevent exactly what the governor wants to avoid.
Let's back up a moment: To people who aren't immersed in health-care policy or the insurance business, the idea of a health-insurance exchange is confusing.
The idea started some time ago with the Heritage Foundation as a private market means of solving the problem of Americans who didn't have health insurance. An exchange would act as a marketplace for insurance companies to offer their products and consumers to buy them at the best price.
The federal health-care law changed that idea dramatically. It requires every state to create an exchange with a much broader and more complex mission.
Medicaid clients could sign up. Businesses looking to offer insurance to their employees could shop for the best deal. And people who don't qualify for Medicaid and don't get insurance through their employers could sign for up private insurance plans and get a federal subsidy to help with the costs.
Last year, the Oklahoma Republican Party split on whether and how to deal with those mandates.
Under pressure from tea party Republicans, three GOP bills to establish exchanges foundered, and Fallin had to tell federal officials to keep a $54 million grant to build an exchange after previously saying the state would accept the money.
After studying the controversy for months, a legislative task force has proposed repurposing the state's Insure Oklahoma program as an exchange.
The proposal would connect eligible Oklahomans to Medicaid and act as a place for businesses to buy insurance for workers, but it would not offer insurance to individuals. So Oklahomans who earn too much to get Medicaid but don't get insurance through their jobs would not have access to the federal subsidies.
The path ahead: A couple of things could happen from here, assuming the plan endorsed by legislative leaders goes into law.
The U.S. Supreme Court could solve the problem by declaring the federal law unconstitutional.
Oklahoma is one of several states challenging the law in court, mostly on grounds that the so-called individual mandate is unconstitutional.
If the Supreme Court declares the entire law unconstitutional before Jan. 1, 2014, Oklahoma ends up with a free-market, state-operated exchange that helps businesses buy insurance together without any federal money and that helps Medicaid clients enroll.
There are three possible hitches in that scenario. The Supreme Court might not rule in time. It might rule that the law is constitutional. Or it might rule that the individual mandate is unconstitutional, but the health-care exchange requirements are. If any of those things happen, Oklahoma could be in a fix.
On the other hand, voters could resolve the issue in November.
The national election could easily become a referendum on the Affordable Care Act. If the White House changes hands and Republicans get big enough majorities in both houses of Congress, the law would likely be overturned, and, once again, Oklahoma is free and clear.
Of course, if Democrats hold on to power, or just hold on to enough power to stymie change, that plan doesn't work either.
Which brings us back to what happens if Oklahoma goes into 2013 with a plan for a health exchange that clearly doesn't comply with the law.
I shopped that question around all week with every national expert I could find, from the conservative Heritage Foundation to the liberal Families USA to the neutral National Conference of State Legislatures. No one knows for sure what happens and how, because the U.S. Department of Health and Human Services hasn't released its rules for compliance with the law.
But unless Congress or the Supreme Court say otherwise the federal law is clear: uninsured citizens have a right to federal health-insurance subsidies through a health-insurance exchange. The state can do it, or the federal government will.
So, the governor's worst-case scenario - a federal exchange imposed on the state - looms as a possibility.
Original Print Headline: State faces health exchange deadline
Wayne Greene 918-581-8308
wayne.greene@tulsaworld.com
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