Detritus wrote:Or maybe Republican gubernatorial intransigence will lead to a unified, federally run healthcare system such as we would not enjoy if their 30 states cooperated with the other 20. After all, 50 separate systems are a lot harder to integrate than 21.
One advantage of federal exchanges is they will further standardize regulation, allowing insurance companies to easily participate in more states. Remember the Republican's big idea - allow people to purchase policies across state lines? Well, standardizing regulation does this job in a realistic way.
The other advantage of federal exchanges is that they prevent sabatoge by ill-intentioned governors. I expect this is a short term problem, and exaggerated in our minds.
The big picture is that federal exchanges, with little state participation, will suck. The more I learn about the process, the more obvious it is that the states need to run them. Maybe in 10 years that will be different, but the exchanges today have to be highly customized.
The other problem is that even after all the policy decisions are made and documented, these are major software projects. It's almost impossible to get them built and debugged by next October.
There is a short-term crisis, not a problem, a crisis. The Feds do not have the funding to operate a large number of exchanges. Think how many customer service people it will take to bring a major program like this online! And they will have to be trained to answer complex questions about medicaid and other plans for a particular state. The Obamacare law was written with the expectation that nearly all states would take an active interest in making the program work for their state.
I can see an argument for a governor shunning a state-based exchange given the short time line. But the Republican rejectionist bloc are also refusing sensible federal-state partnerships. It's obvious they are engaged in a coordinated strategy to ruin the Obamacare rollout.
Somehow this job will get done. But it's going to be ugly, with a lot of unnecessary difficulty and finger pointing.