AC Alert for November 26, 2012 Decision Time Again for States on Healthcare Issues

Nov 27, 2012 2:00 PM ET

Deadlines coming for the states -- The Affordable Care Act, or "Obamacare" is kicking in important deadlines at the state level. When President Obama's promise of healthcare reform was signed into law, the legislation included a provision whereby the individual states would need to decide by this November whether they wished to establish their own healthcare insurance exchange, or to opt into the federal government's version. The individual exchanges will actually be websites, designed to lead people through the process of selecting a health insurance plan, based on price and coverage. In the process, users will be able to determine whether they qualify for subsidies or in some cases for state-level Medicaid.

A significant number of states led by Republican governors held off on making their decisions on this issue hoping that the GOP would recapture the White House, and "Obamacare" would either be repealed or radically changed.

With the President's re-election, it is now apparent that the existing healthcare law will remain in effect. While the deadline has been pushed back to December 14, this still leaves the impacted states with a very short time to make important decisions. The result has been an interesting contrast of decisions from the various statehouses.

As of November 19th as this commentary was being prepared,

  • 18 states have indicated they will create a state-run exchange
  • 16 states will not
  • In those 16 states, the federal government will have to step in
  • Six other states, including North Carolina, have agreed to a state-federal partnership exchange
  • 11 states remain undecided at this writing


The District of Columbia is included in the states establishing its own exchange. Any state that opts out of the effort will be saddled with a one-size-fits-all insurance exchange that, paradoxically, will be built by the federal government. In effect, the state will lose its traditional authority over health-insurance operations, and will be unable to tailor its exchange to suit the desires of either local insurers or residents.

Such a state apparently wouldn't save money either, as the federal government is picking up the bill for creating exchanges and, under the law, once exchanges are in operation, they are to be self-supporting through fees paid by insurance companies.

The healthcare exchange, if structure properly, can serve as an important part of the overall law, notes AC's featured commentator Robert McMillan: "As I speak [to groups] across Long Island, New York and the West Coast of Florida about healthcare reform, I have never seen more confusion, fear, and frustration. It reminds me of the efforts of first-lady Hillary Clinton in 1993 and 1994 to pass healthcare reform..."

Bob McMillan offers eight vital steps that he feels need to be done on the healthcare issue. One of those is establishing the healthcare exchanges. "The idea of an insurance exchange is probably positive so that both the uninsured and employers could explore options and obtain the best coverage for the lowest cost." (Source: Robert R. McMillan commentary).

Bob should know, having served for over 30 years of corporate, governmental and not-for-profit board experience, especially in the US$2.5 trillion healthcare industry (Bob, an attorney, served on the boards of Lumex, Inc., WellChoice, Inc., and was a lay member of the board of the American Medical Association/AMA).

As the various aspects of the new health care law emerge for implication, the nation remains engaged in one of the most heated and emotional government public policy debates in recent years. 

In our special Healthcare Dialogue Hot Topic, the editors of Accountability Central are focused on this issue, presenting the news, opinions and research generated by some of the best minds and institutions in the nation. Here are some recent excerpts:

Obama Healthcare Reform: Five Republican Governors Reject State-Run Health Markets (Source: Huffington Post) Five Republican governors have rejected setting up on-line health insurance markets where consumers can purchase private coverage at federally-subsidized rates. That makes it likely that the federal government will establish its own markets, known as healthcare exchanges, in those states and potentially supplant state control of private individual insurance markets.

States get more time to decide whether to build health exchanges
(Source: Washington Post) States now have until December 14 to notify the federal government whether they intend to operate the new insurance marketplace at the heart of the health reform law. The decision came in response to a letter from Virginia Governor Robert F. McDonnell and Louisiana Governor Bobby Jindal asking President Obama to push back the impending November deadline.

Health care reform: Next steps
(Source: Star Tribune) The newspaper outlines the next steps in implementing the Affordable Care Act.

Doctor Shortage Could Cause Health Care Crash
(Source: ABC News) The United States will require at least 52,000 more family doctors in the year 2025 to keep up with the growing and increasingly older U.S. population, according to a new study published Monday in the Annals of Family Medicine. The predictions also reflect the passage of the Affordable Care Act, which will expand health insurance coverage to an additional 38 million Americans.

Hospitals fear effect of fall off fiscal cliff
(Source: Crain's Cleveland Business) Should the United States fall off the so-called "fiscal cliff," Northeast Ohio's health care providers would stomach millions of dollars in revenue cuts their leaders say could gnaw away at their already-slim operating margins.

Health Care Reform Rules Give Patients A New Bill Of Rights
(Source: Huffington Post) Health insurance consumers won't be discriminated against because of pre-existing conditions, can't be charged more because of gender and will be guaranteed a basic set of benefits under new federal regulations. The regulations carry out the promises of President Barack Obama's health care reform law, which will extend health insurance coverage to 30 million people over a decade and outlaw some of the industry's most notorious practices.

This is just a sampling of the information in our Alert. Go here for the full text of this alert, and more information on Sustainability, and other Accountability related topics