Health
Law Has States Feeling Tense Over Deadline
Published: November 14, 2012 - New York Times
DES MOINES — The days since President
Obama won re-election have been marked by tension and angst in
Republican-led states like Iowa, where Gov. Terry Branstad has waited until the
last minute to decide whether to create a crucial tool for people to get medical
coverage under Mr. Obama’s health care law.
“There has been a total blackout of information,” said
State Senator Jack Hatch, a Democrat who vented his frustration at a news
conference here this week. “We’re behind schedule, we’re at a disadvantage, and
I don’t know what our governor’s plan is to reposition Iowa.”
States are supposed to tell the Obama administration
by Friday whether they want to create their own health
insurance exchange — a deadline that many had bet might never come to pass,
choosing to sit on their hands for months in the hope that Mitt
Romney would win the presidency and the health care law would be repealed.
On Wednesday, they dug in their heels a little more.
Leaders of the Republican Governors Association, gathering in Las Vegas for
their annual meeting, wrote a letter to Mr. Obama requesting more time, more
guidance and a meeting where the president and governors could talk.
“States are struggling with many unanswered questions
and are not able to make comprehensive, far-reaching decisions prudently,” Gov.
Bob McDonnell of Virginia, the chairman of the association, and Gov. Bobby
Jindal of Louisiana, its next chairman, wrote.
Insurance exchanges — basically online markets where
the uninsured can shop for private health insurance, often with federal
subsidies to help pay — are considered critical to making the health care law
work. So far, 17 states, most led by Democrats, and the District of Columbia
have indicated they will create their own state-run exchanges.
The other options are setting up an exchange in
partnership with the federal government, or simply letting the federal
government do it.
Every state is supposed to have an exchange by Jan. 1,
2014, when the health care law will require most Americans to have insurance.
The exchanges are supposed to be ready to start enrolling people in October
2013.
Despite the unhappiness, there are indications that
some Republican governors may be softening their opposition to the law. Gov.
Rick Scott of Florida, a Republican who had been one of its toughest critics,
signaled this week that he would be open to compromising.
“The election is over, and President Obama won,” Mr.
Scott told The Associated Press. “If I can get to yes, I want to get to yes.”
And Governor McDonnell of Virginia — like Florida, a
state Mr. Obama carried — noted that while his state had been the first to file
suit seeking to block the law, it would comply with it.
But he said that the complexity of the law, and the
lack of details from Washington, meant that “my best experts in Virginia, my
doctors and others that are advising me on what to do, say they still can’t make
a prudent call between a state or federal exchange because we don’t have all the
answers.”
Others are facing intense, sometimes conflicting
pressures from state legislators and interest groups. In Wisconsin, health care
providers and business groups are lobbying Gov. Scott Walker to create a state
exchange, while Tea
Party groups are warning him not to.
At the Republican governors meeting in Las Vegas, Mr.
Walker said in an interview that he would prefer a state-based program, but that
he doubted that the federal government would allow him to shape it as he saw
fit.
“I’d much prefer control at the state level,” Mr.
Walker said, “but the problem is, I don’t think they are really state-run.”
He said that he would not disclose his decision until
Friday, but added, “Why do I want to take on the potential risk to my taxpayers
if I don’t really have any true authority about what’s going to happen?”
Republicans who support state-run exchanges say they
are embracing a fundamental conservative belief: that states should make their
own decisions rather than cede control to the federal government. But others
argue that deferring to the federal government is a shrewder move; that way,
they say, it will not be their fault if anything goes wrong.
“It’s a federal program, it’s primarily designed to
give federal premium tax subsidies, and it’s all tied up in federal
regulations,” said Tony Keck, director of the Department of Health and Human
Services in South Carolina, which has rejected the idea of running its own
exchange. “So to ask states to get involved is like asking states to run the
post office. It doesn’t make sense.”
Abby Goodnough reported from Des Moines, and Michael Cooper from Las Vegas.
Jeff Zeleny contributed reporting from Las Vegas and Jess Bidgood from
Boston.