Tuesday, January 15, 2013

HHS Secretary Sebelius To Give State-Federal Health Insurance Exchanges More Time

This is both smart politics -- and a nod to many of the Republican-led states -- it is Mr. Obama signalling that he will be open to constructive suggestions for a partnership here.

Even so, in states like Florida, it is hard to imagine why Governor Rick Scott (R) is comfortable with over 3.8 million of his fellow Floridians having no coverage at all. That is both morally, and politically, a backward facing vision.

For in the end, refusing to cover all simply shifts the economic burden of caring for these un-insured folks -- to the front doors of Florida's hospitals -- without any real rhyme, or reason. Accidents of local geography then dictate which charitable hospital(s) pay the tab for the uninsured -- for we know the for-profit hospitals simply turn them away.

That is not sound public policy -- and has been repeatedly demonstrated to be an extremely expensive way to deliver the health care the uninusred. The uninsured are going to get the care (usually at the ER, in the nearly most expensive setting possible), anyway (when what was a mild flu -- long untreated -- has escalated to a life-threatening situation) -- why not do it in a thoughtful, less expensive, more systemic way (i.e., a more-preventative way)?

Mr. Scott well knows all of this -- but his politics are hamstringing his ability to do what is clearly in his state's interest, and let the federal government help him pay for 95 percent of the cost of care (in the early years, ultimately dwindling to 85 percent -- in later years).

From The New York Times, then, this morning:
. . . . Kathleen Sebelius, working with the White House, said she would waive or extend the deadline for any states that expressed interest in creating their own exchanges or regulating insurance sold through a federal exchange.

A political benefit of this strategy is that it allows the administration to keep working with even the most recalcitrant states. Administration officials said they were trying to persuade such states to share the work of running an exchange, supervising health plans and assisting consumers.

The exchanges are a crucial element of President Obama’s health care law. Every state is supposed to have one by October, and most Americans will be required to have coverage, starting in January 2014. The federal government will run the exchange in any state that is unwilling or unable to do so. It now appears that federal officials will have the primary responsibility for running exchanges in at least half the states — far more than expected when the law was passed in 2010.

Ms. Sebelius has given “conditional approval” to 17 states that want to run their own insurance exchanges. The 17 include Utah, where officials have said they are reluctant to perform some functions of an exchange. . . .

We will, of course, keep you up to date on this topic.

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