The Health Care Exchange Debate
The Patient Protection and Affordable Care Act (ACA), the landmark health care reform law, calls for the establishment of health care exchanges in each state, which are entities that will streamline the health insurance market options for consumers. Each state is required by law to set up its own health care exchange by January 1, 2013; if any have not created an exchange by that point, the federal government will establish a program for the state. The exchanges will open January 1, 2014.
The unique dynamic of each state has evinced some interesting approaches to tackling this ACA requirement. The party affiliation of a state legislature and/or governor has indeed influenced the degree to which states are willing to cooperate with the law.
In April, New York Governor Cuomo (D) created an exchange by executive order because the Republican-dominated State Senate refused to pass legislation last fall, costing the state the chance to receive millions of federal dollars to support the program. Last week, New Jersey Governor Chris Christie (R) vetoed a bill passed by the Democratic-led state legislature that would have created an exchange for the state.
Granted, not every state action—or lack thereof—on the health insurance exchanges can be explained by party affiliation. For example, Mississippi’s Republican insurance commissioner is setting up an exchange with approval from the state’s Republican governor, even as Mississippi remains part of the lawsuit challenging the constitutionality of the ACA. And Democratic lawmakers in Arkansas have not taken any steps to create that state’s exchange.
Many governors and lawmakers are hoping to postpone action on the exchanges until the Supreme Court hands down a decision on the constitutionality of the ACA, expected late June. Regardless of the outcome of the case, some Republican leaders also hope the November elections will prove fruitful for their party and allow them to repeal the whole law. Of course, should the law survive, those state leaders will have to decide whether they would prefer to design their own exchanges or hand the reins over to the federal government—and given the January 1, 2013 deadline to set up their own exchanges, states are quickly running out of time.
The exchanges are a key piece of the ACA, helping to educate consumers and expand health care to millions of individuals through the availability of subsidies to purchase plans. The Reform Movement is a strong supporter of the ACA precisely because it helps make health care more affordable and accessible. It is for this reason that Maimonides, a revered Jewish scholar, listed health care first on his list of the ten most important communal services a city could offer its residents.
Photo courtesy of kff.org