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Health law setting up U.S. experiment

States, feds face off over exchanges

  • FILE -In this Dec. 28, 2011 file photo, then-Nebraska Sen. Ben Nelson, currently National Association of Insurance Commissioners CEO, smiles during an interview with The Associated Press in his Omaha, Neb office.  President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? (AP Photo/Dave Weaver, File)

    FILE -In this Dec. 28, 2011 file photo, then-Nebraska Sen. Ben Nelson, currently National Association of Insurance Commissioners CEO, smiles during an interview with The Associated Press in his Omaha, Neb office. President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? (AP Photo/Dave Weaver, File)

  • FILE -In this Dec. 28, 2011 file photo, then-Nebraska Sen. Ben Nelson, currently National Association of Insurance Commissioners CEO, smiles during an interview with The Associated Press in his Omaha, Neb office.  President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? (AP Photo/Dave Weaver, File)

    FILE -In this Dec. 28, 2011 file photo, then-Nebraska Sen. Ben Nelson, currently National Association of Insurance Commissioners CEO, smiles during an interview with The Associated Press in his Omaha, Neb office. President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? (AP Photo/Dave Weaver, File)

  • FILE - In this June 28, 2012 file photo, Kansas Insurance Commissioner Sandy Praeger speaks in Topeka, Kansas. President Barack Obama’s health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds?  The nation is about evenly split between mostly blue states that decided by Friday’s deadline they want a say in running new insurance markets and mainly red ones defaulting to federal control because they want nothing to do with “Obamacare.”  (AP Photo/John Hanna, File)

    FILE - In this June 28, 2012 file photo, Kansas Insurance Commissioner Sandy Praeger speaks in Topeka, Kansas. President Barack Obama’s health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? The nation is about evenly split between mostly blue states that decided by Friday’s deadline they want a say in running new insurance markets and mainly red ones defaulting to federal control because they want nothing to do with “Obamacare.” (AP Photo/John Hanna, File)

  • FILE - In this June 28, 2012 file photo, Kansas Insurance Commissioner Sandy Praeger speaks in Topeka, Kansas. President Barack Obama’s health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds?  The nation is about evenly split between mostly blue states that decided by Friday’s deadline they want a say in running new insurance markets and mainly red ones defaulting to federal control because they want nothing to do with “Obamacare.”  (AP Photo/John Hanna, File)

    FILE - In this June 28, 2012 file photo, Kansas Insurance Commissioner Sandy Praeger speaks in Topeka, Kansas. President Barack Obama’s health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? The nation is about evenly split between mostly blue states that decided by Friday’s deadline they want a say in running new insurance markets and mainly red ones defaulting to federal control because they want nothing to do with “Obamacare.” (AP Photo/John Hanna, File)

  • FILE -In this Dec. 28, 2011 file photo, then-Nebraska Sen. Ben Nelson, currently National Association of Insurance Commissioners CEO, smiles during an interview with The Associated Press in his Omaha, Neb office.  President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? (AP Photo/Dave Weaver, File)
  • FILE -In this Dec. 28, 2011 file photo, then-Nebraska Sen. Ben Nelson, currently National Association of Insurance Commissioners CEO, smiles during an interview with The Associated Press in his Omaha, Neb office.  President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? (AP Photo/Dave Weaver, File)
  • FILE - In this June 28, 2012 file photo, Kansas Insurance Commissioner Sandy Praeger speaks in Topeka, Kansas. President Barack Obama’s health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds?  The nation is about evenly split between mostly blue states that decided by Friday’s deadline they want a say in running new insurance markets and mainly red ones defaulting to federal control because they want nothing to do with “Obamacare.”  (AP Photo/John Hanna, File)
  • FILE - In this June 28, 2012 file photo, Kansas Insurance Commissioner Sandy Praeger speaks in Topeka, Kansas. President Barack Obama’s health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds?  The nation is about evenly split between mostly blue states that decided by Friday’s deadline they want a say in running new insurance markets and mainly red ones defaulting to federal control because they want nothing to do with “Obamacare.”  (AP Photo/John Hanna, File)

President Obama’s health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds?

The nation is about evenly split between states that decided by Friday’s deadline they want a say in running new insurance markets and states that are defaulting to federal control because they don’t want to participate in “Obamacare.” That choice was left to state governments under the law: Establish the market or Washington will.

With some exceptions, states led by Democrats opted to set up their own markets, called exchanges, and Republican-led states declined.

Only months from the official launch, exchanges are supposed to make the mind-boggling task of buying health insurance more like shopping on Amazon.com or Travelocity. Millions of people who don’t have employer coverage will flock to the new markets. Middle-class consumers will be able to buy private insurance, with government help to pay the premiums in most cases. Low-income people will be steered to safety net programs like Medicaid.

“It’s an experiment between the feds and the states, and among the states themselves,” said Robert Krughoff, president of Consumers’ Checkbook, a nonprofit ratings group that has devised an online tool used by many federal workers to pick their health plans. Krughoff is skeptical that either the feds or the states have solved the technological challenge of making the purchase of health insurance as easy as selecting a travel-and-hotel package.

Whether or not the bugs get worked out, consumers will be able to start signing up Oct. 1 for coverage that takes effect Jan. 1. That’s also when two other major provisions of the law kick in: the mandate that almost all Americans carry health insurance, and the rule that says insurers can no longer turn away people in poor health.

Barring last-minute switches that may not be revealed until next week, 23 states plus Washington, D.C., have opted to run their own markets or partner with the Obama administration to do so.

Twenty-six states are defaulting to the feds. But in several of those, Republican governors are trying to carve out some kind of role by negotiating with federal Health and Human Services Secretary Kathleen Sebelius. Utah’s status is unclear. It received initial federal approval to run its own market, but appears to be reconsidering.

“It’s healthy for the states to have various choices,” said Ben Nelson, CEO of the National Association of Insurance Commissioners. “And there’s no barrier to taking somebody else’s ideas and making them work in your situation.” A former U.S. senator from Nebraska, Nelson was one of several conservative Democrats who provided crucial votes to pass the overhaul.

States setting up their own exchanges are already taking different paths. Some will operate their markets much like major employers run their health plans, as “active purchasers” offering a limited choice of insurance carriers to drive better bargains. Others will open their markets to all insurers that meet basic standards, and let consumers decide.

Obama’s Affordable Care Act remains politically divisive, but state insurance exchanges enjoy broad public support. Setting up a new market was central to former Republican presidential candidate Mitt Romney’s health care overhaul as governor of Massachusetts. There, it’s known as the Health Connector.

A recent AP poll found that Americans prefer to have states run the new markets by 63 percent to 32 percent. Among conservatives the margin was nearly 4-1 in favor of state control. But with some exceptions, including Idaho, Nevada and New Mexico, Republican-led states are maintaining a hands-off posture, meaning the federal government will step in.

“There is a sense of irony that it’s the more conservative states” yielding to federal control, said Sandy Praeger, the Republican insurance commissioner in Kansas, a state declining to run its own exchange. First, she said, the law’s opponents “put their money on the Supreme Court, then on the election. Now that it’s a reality, we may see some movement.”

They’re not budging in Austin. “Texas is not interested in being a subcontractor to Obamacare,” said Lucy Nashed, spokeswoman for Gov. Rick Perry, who remains opposed to mandates in the law.

In Kansas, Praeger supported a state-run exchange, but lost the political struggle to Gov. Sam Brownback. She says Kansans will be closely watching what happens in neighboring Colorado, where the state will run the market. She doubts that consumers in her state would relish dealing with a call center on the other side of the country. The federal exchange may have some local window-dressing but it’s expected to function as a national program.

Christine Ferguson, director of the Rhode Island Health Benefits Exchange, says she expects to see a big shift to state control in the next few years. “Many of the states have just run out of time for a variety of reasons,” said Ferguson. “I’d be surprised if in the longer run every state didn’t want to have its own approach.”

In some ways, the federal government has a head start on the states. It already operates the Medicare Plan Finder for health insurance and prescription plans that serve seniors, and the Federal Employees Health Benefits Program. Both have many of the features of the new insurance markets.

Administration officials are keeping mum about what the new federal exchange will look like, except that it will open on time and people in all 50 states will have the coverage they’re entitled to by law.

Joel Ario, who oversaw planning for the health exchanges in the Obama administration, says “there’s a rich dialogue going on” as to what the online shopping experience should look like. “To create a website like Amazon is a very complicated exercise,” said Ario, now a consultant with Manatt Health Solutions.

He thinks consumers should be able to get one dollar figure for each plan that totals up all their expected costs for the year, including premiums, deductibles and copayments. Otherwise, scrolling through pages of insurance jargon online will be a sure turn-off.

To Gen_X_er (no reply button): I'm especially glad that you understand how the debt started to snowball under Reagan, because, going by your screen name, you are of a generation that did not cause the problem with your vote. In fact anyone under the age of 50 couldn't have voted for Reagan in 1981. I voted then, and I witnessed the big mistake that started the runaway debt problem: huge tax cuts for the wealthy that continue to this day, along with out of control finance charges on top of finance charges times 30 years. So, for all the younger people who are having this gigantic debt forced upon them, and for any others who can't understand the math, I think I should continue to explain why this is happening, and offer ideas for solutions. Here are a few: 1. All pre-Reagan tax rates should be phased in over 5 to 10 years. 2. Lower cost national health care, paid for 50/50 through individual income taxes and a national sales tax, would reduce (cut) government spending, simplify government by wrapping all existing health care related programs into one, reduce the cost of American manufacturing, help bring our jobs back from China, and increase GDP along with income tax and national sales tax revenue. 3. Fund Social Security 50/50 through individual income tax revenue and a national sales tax. 4. Eliminate all employer contributions to Social Security and to all health related programs. 5. Eliminate all employee payroll deductions other than income tax, with several higher progressive tax brackets.

Earthling, I have recently been reading up on these topics of tax cuts, deficits and how they effected the middle class. It's not like reading a mystery novel--it's tough reading. Maybe that's why most people are unaware of how we got ourselves into this mess. Money has corrupted our political system. There's an army of full-time, smart, well-paid ex-politicians lobbying Congress to sneak all kinds of tax cuts for the wealthy and financial deregulation into our laws. Politicians have to listen if they want to raise any money to get re-elected. Reps and Dems both. These tax cuts come at the expense of even huge deficits. This is not what a democracy is supposed to be. I think term limits would do a lot of good to fix the problem. Ironically, it's not just the middle class that has suffered. Even the earning power of the upper-middle class has declined. Only the top 5% has benefited. By now Washington politics is so polarized I don't know if anything can be done.

I agree, except that I have to believe there are responsible and sensible things that "can be done" to gradually steer this nation onto a better course and to start bringing the debt problem under control. I listed some ideas, but we need to do a lot more to fix this mess. One positive is that interest rates are extremely low currently. Most of the $400B/yr of interest expense is a product of debt issued at much higher rates in the past. Under Reagan rates were up around 14%, but have been declining ever since. Reagan's bonds don't all mature until 2019. As we are seeing now with short sales in housing, debtors in default and buyers can negotiate with lenders. I think some negotiating should be done between the Treasury and wealthy holders of high rate 30 year bonds by gradually calling them and reissuing them at the current rate (or at a new adjustable rate). This could take a big bite out of our deficit spending on interest. I think we also need to stop allowing the Treasury to steal money from our SS and other trust funds, and make the Treasury gradually pay all those $Ts back by issuing public debt - this would cause no increase of our total US debt. Then the trust funds could invest those $Ts into low risk income producing assets that benefit everyone (including the wealthy), mostly other than US securities, such as mortgage loans, farm land to lease, municipal bonds for schools and infrastructure, etc. Another positive is that we now have the internet so that we can go on the politician's facebook pages and help them with their K-8 math.

Romney gets richer and richer by sending our manufacturing jobs to China where employers pay no costs of health insurance, Medicare, Medicaid. Meanwhile all Chinese citizens are covered for health care through a national program that is funded by individual income tax and sales tax, both of which are not added into the price of the Chinese products on our store shelves. Conservatives must like the anti-American job outsourcing and the expensive and complicated health care mess we have here - otherwise they would cut spending and bring our jobs back from China by adopting simple and lower cost standardized national health care, funded through individual income taxes and a national sales tax. Maybe offer a private option voucher for anyone who loves helping a private health insurance company make big profits while denying preexisting conditions and doubling the cost every few years.

I suggest earthling you read up on the stimulus money and where it went. The Outsourcer In Chief sent billions to countries like England, Finland, China, Brazil etc. GM sold it's specs to China for cars. And we have windmills, solar panels, electric batteries etc all being made overseas thanks to the stimulus give away. That is how the taxpayer money was spent. The President at an Indiana truck plant talking about electric trucks that would stimulate jobs in the US. Behind him is an electric truck made in England., Yeah he gave stimulus money to England to build those trucks. It amazes me how so many folks are uninformed about what this President is saying and what he is actually doing with taxpayer money. He is definitly the Outsourcer In Chief. Don't bellieve me, look it up.

So do you really think most of these stimulus items went to foreign countries?: http://www.recovery.gov/Transparency/fundingoverview/Pages/fundingbreakdown.aspx#ContractsGrantsLoans Who received most of Reagan's 189% debt increase? How about Bush's 89% debt increase? Do you realize that so far under Obama we have spent over $1.7 trillion just on interest expense, mostly on the Reagan and Bush tax cut/big spender debt Obama inherited. Here's a clue about why the debt started snowballing in the 1980s: The 50 year average top bracket rate was 79% prior to the Reagan trickle down tax cut give away to the rich, and for the last 30 years that rate has averaged about 38%. (extra hint: 38% is less than half of 79%). If you happen to have a 30 year mortgage, take a look at the total interest you will pay over 30 years and see how it compares to the amount borrowed initially. Then imagine what the extra interest would cost if you were like Reagan and Bush and doubled or tripled the mortgage to hand out tax cuts to wealthy people without making any payments.

Earthling, it's no use. You've made this argument time and again on this forum. Apparently deficits only matter when there's a Democrat in the White House.

the hallmark of democrats is that they are always doubling down on their failed policies

The reality of the ACA is about to become evident to all. It will fail on it's own because of how it is set up. Folks are also about to see the cost. Health Care providers will stop accepting Medicaid and Medicare patients because of low reimburesments. When folks accept a plan and totally ignore how it is set up, then you will find out what that plan really does. The left has no clue how to run anything.

Neither will get everyone insured and neither will make sure that it is "affordable". It penalizes people who can least afford insurance and forces all of us into what will be a rationed system where bureaucrats will ultimately decide if 70 year old grandpa gets the knee surgery after he has worked his fingers to the bone for 50+ years or whether some illegal immigrant will get seen for a cold. This bill was rammed through the progressive Congress as they fed like pigs at the trough to get their constituent and dependency building legislation passed. It was done in a sneaky and nasty way and who can forget Nancy Pelosi's famous quote: "We need to pass the bill so that people can find out what is in it". How any semi-intelligent citizens can imagine that this will be anything other than a money pit is stunning. I guess if your "feel" good that people will be covered and you live day to day versus for the future, it makes sense. Again, progressives emotions clearly eclipse their common sense and intelligence.

You're right in that it will not cover everyone nor will it make health care affordable. Only a single-payer system can do that. And I think that one day we will have one in this country despite the intense lobbying of the health insurance and pharmaceutical companies. Until then we have Obamacare which will at least keep insurance companies from cherry-picking the insured, eliminate the "pre-existing conditions" clause, allow kids to stay covered on their parents plans among other things.

Single payer would even be worse. It would mean vanilla health care for everyone. You do realize that single payer in other countries results in rationing. I hope that your single payer supporters are ready to be told: "sorry, we need to give you pain killers and you can fade away". If you are gainfully employed then you have a 90% chance of having a health care plan with your employer. Heck, even McDonalds and Burger King offer a plan to hourly employees. No company paid insurance denies anyone any coverage based on "pre-existing" conditions. Those stories are a red herring and if you get private insurance, why should they not consider that? Are they charities that offer you a policy for $10,000 per year to give you $500,000 in services. That is a fantasy land view of the world. Any kid graduating from college who stays at home until the age of 26 is a pretty sad example of an educated person. And if you want a job and can't find one after graduation there are two reasons for that. The first one is that Obama has done nothing to improve the economy and this is squarely on his shoulders. The other is that few professions hire your right out of college and a high salary. Yes the professors tell you that but college is a piece of paper, without deep experience, you are not qualified for much.

Single-payer has been effectively utilized by virtually every other modern democracy in the world. They provide health care to ALL of their citizens at a MUCH lower cost than we do. Many provide a quality of care even higher than here. The real reason that we do not have single-payer here in the US is because the health insurance companies 1) very effectively lobby our legislators and 2) have managed to frighten people into thinking government wants to "take over" health care. Now, there are many, many working class folks out there who are not even offered health insurance and many, many more who cannot even afford a bare-bones policy. Not everyone has gone to college--nor do they have to to do their job. The health and lives of working class folks are no less valuable than those who went to college (I being one of them).

ItsaRepublic - you are dead wrong with your statement "No company paid insurance denies anyone any coverage based on "pre-existing" conditions." I can tell you first hand that many companies do allow pre-existing but there are many that do not. Most people when faced with a child born with an illness is that they go try to find a company that will cover the child and work for them. I was not able to find "even one" private insurance policy that would cover my child, they would not even give me a cost quote. That's why it is included in Obamacare.

The sneakiest and nastiest thing about getting the ACA through Congress was the way Republicans fought against even DISCUSSING the bill. Mitch McConnell and Co cajoled and threatened any GOP senator who even showed a sign at giving the bill a chance. In public they trumpeted the famous "death panel" argument. Olympia Snowe was the only one to give it a chance and now she's resigned from the Senate. It's no secret that she's had enough of the strong-arming and polarizing tactics of the GOP.

Olympia Snowe and her husband are about to be sued by 11 states and the Dept of Justice. He is chairman of the board of a company that has been accused of taking fed money for students illegally. The states and the Feds are seeking 10 billion back from the company. Company was bought out by Goldman Sachs, and guess who cast the deciding vote for GS to get stimulus funds. You guess it Snowe. That is why she retired. She is corrupt, and my guess is the Obama Admin wanted her out, so that is why the DOJ investigation. They want a Dem in Maine.

"Texas is not interested in being a subcontractor for Obamacare" per Rick Perry's spokeswoman. Ironic in that Texas has the highest rate of uninsured residents in the country. So now instead of setting up their own system they're going to have the federal government do it for them. Good thinking guv'na. Even now, after Congress has passed the Affordable Care Act, the US Supreme Court judged it legal and the threat of a Romney veto gone (also ironic that Romneycare was a blueprint for the ACA), Republicans are fighting it tooth and nail. This morning Sen Lindsey Graham suggested scrapping Obamacare to save save money and avoid the sequester. Puh-lease....Obamacare is here to stay, GOP. Get used to it! It's not a perfect plan but it's better than the Republican's plan which is....er, well, ah....

...vouchers?

Yes, vouchers, a must better plan.

Oh yeah. Vouchers. Except the public has shown virtually no support for it whatsoever.

Vouchers are a right-wing fantasy that no other modern society uses for health care. Modern medicine does not function as a free market. It's a natural monopoly--everyone needs health care, it's never an option, and everyone needs the same kind of high quality care--with M.D.s at the top of the health care monopoly ladder. Without regulation like a public utility, the drug companies and the insurance companies are free to raise prices as they've long done in this country. We pay more than any other country for health care, yet have poorer outcomes than all the other advanced democracies. Vouchers in the absence of cost controls via regulation would be a big mistake.

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