At one time, Gov. Sean Parnell said he would take “weeks or months” to decide on whether or not to follow the lead of some prominent fellow Republican governors in rejecting certain provisions of the Affordable Health Care Act. But last week his decision to let the federal government create a health exchange for Alaska’s growing number of uninsured clearly indicates that Parnell has decided that playing politics is more important than tailoring a health insurance exchange for Alaska’s unique remote conditions. Parnell now joins Rick Perry of Texas, Rick Scott of Florida, Bobby Jindal of Louisiana and Nikki Haley of South Carolina in rejecting the option to create a state health insurance exchange.
But first, what is a health insurance exchange? Setting up an exchange is an attempt to inject some retail competition into places being served by a limited number of health providers. Theoretically, they’d allow individuals and small businesses to band together and get better prices and more variety in health insurance options — the kinds of breaks that big corporations can negotiate for their employees today.
I understand this was originally a Republican idea to use components of the marketplace to create more competition to drive down insurance costs. President Obama not only accepted but promoted the concept of a health insurance exchange as a key component of his health reform initiative. Obama stated that it should be “...a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that’s best for them, in the same way that Members of Congress and their families can.”
The health care law, recently upheld by the Supreme Court, includes a provision that if the state chooses not to set up an exchange, the federal government will do so for the residents of that state. This is all part of bringing the millions of uninsured into a viable health care system. To entice the state to develop these exchanges the federal government provides planning grants and subsidizes the operation, ensuring that this is not an unfunded federal mandate.
Now back to Parnell’s action. As noted in the Juneau Empire (July 18), the governor is basing his decision to not pursue a state exchange on fiscal matters. In a press release announcing his action he says, “It doesn’t make sense to spend Alaskans’ dollars to set up an exchange when so much uncertainty exists about how to implement it and how to gain federal approval.” Sounds perfectly reasonable on face value, however it turns out the only reason why Alaskan dollars would be at all involved is because Parnell decided to be the only governor in the country to reject federal funds for planning a state health exchange. Even those Republican governors rejecting the state health exchange option accepted funds for planning.
If I’m tracking the governor’s fiscal message right, this means that Parnell is basing a critically important policy decision on “not having funds because I didn’t take them.” Huh? This is just as baffling as why a Governor who often rails about the intrusions of the federal government and sues them every chance he gets, would now prefer the federal government?
Next we learn that Parnell is choosing this peculiar path contrary to a department’s consultant report and staff recommendation. As noted in a report quoted in a Juneau Empire story (July 25), “State staff indicate a strong desire for the State of Alaska to find a State specific solution for exchange creation and a preference to not rely on federal solutions.” Does this suggest that even the state knows that it’s not in the state’s best interest to hand this off to the federal government?
The absurdity continues. Michael O. Leavitt, a former Governor of Utah and federal health secretary and now a top aide to Republican presidential candidate Mitt Romney, recently stated in a New York Times article that it would be better for the states to create their own exchanges for their respective markets or risk “an Obama-style federal exchange being foisted upon a state.” When someone of Mr. Leavitt’s stature says this publicly, this creates what politicians call ‘political cover’. In essence, former Gov. Leavitt, provided Parnell a way to be in step with his party and yet act for the state’s overall best interest.
If you’re not totally confused by all the inconsistencies, let me re-cap the scenario. Governor Parnell first rejects federal funds to plan for and create a state health insurance exchange. Then despite his dislike for the federal government, he hands the program back to the federal government, citing he did not want to spend Alaska dollars to figure this out. He does this despite the recommendation of his own staff — who by the way remain loyal in stating “what is relevant is the governor’s decision after considering all the factors.” He does this despite having the political cover to do otherwise.
Unfortunately, there is more to the story than just confused decision-making, there is the loss of Alaskans addressing the needs of our uninsured (estimated to grow to 77,000) and small businesses. This is a ridiculously high price to pay for stubborn ideology which as far as I can tell was the only factor the governor considered in his decision to reject a state run health exchange.
• Troll is a longtime Alaska resident and resides in Douglas.
Comments (12)
Add comment100% Agree
He's going out of his way to be difficult. He's not even offering his own ideas as to what will help Alaskans suffering without access to affordable care.
Should healthcare be available only to the wealthy? What will stop run-away cost inflation and how can we all access the system? Parnell's attitude toward our president and toward struggling Alaskans is not OK.
He's OK with standing by while Alaskans die so he can play his political game. I hope this wrong is righted in the next election!
Alaska is singularly unique in our population among
the fifty states with something over 700,000 'crammed' together over a state nearly three times the size of the next largest in the Union.
Exactly how does "pooling" together these numbers improve things?
If the Federal Government desires to pump funds into my state to put me at par with my Alaska Native neighbors I am all for it.
But creating some 'exchange' which will somehow allow Alaska to 'pool' it's resources? These 'exchanges' are starting to sound a lot like a new term for 'redistribution'.
Troll is a "Troll". she is
Troll is a "Troll". she is angry because he refused the "free" handout, work for it Kate.
yeah, what kd II said
and, who's read the whole ACA? I suspect there are hidden nuggets in there that would obstruct rather than help Alaska's unique posture. There's good reason to suspect that, too. With the details being ratcheted by HHS thru regulation, don't expect the exception (Alaska's remoteness) to be accomodated by the norm (contiguous 48).
Logic versus ideology
I agree with the article, unfortunately Kate assails the governor with logic and facts, something that never works with people who cover their lack of critical thinking skills with ideology, or "faith" as it is otherwise known. Just see the above comments for examples.
Good article, but "you cannot argue with someone who is right".
Thank you Gov. Parnell. From
Thank you Gov. Parnell.
From The American Spectator -
"The exchanges didn't receive the attention their importance merits while the press, public, and political establishment remained intently focused on Obamacare's individual mandate and the possibility that it might be ruled unconstitutional. The law calls for the states to set up these new bureaucracies, whose ostensible purpose will be to provide "marketplaces" in which people with no employer-based health insurance can shop for coverage at competitive rates. Now that the Court has upheld the individual mandate, these insurance exchanges constitute the key to the success or failure of the law. They are also its Achilles' heel.
How's that? Well, as the Cato Institute's Michael Cannon succinctly puts it, "Without these bureaucracies, Obamacare cannot work." And, oddly enough, the law doesn't actually require states to set up these "marketplaces." Moreover, there is no rational incentive for them to do so. If a state sets up an exchange, it then must pay for it, which won't be cheap. Cannon writes, "States that opt to create an exchange can expect to pay anywhere from $10 million to $100 million per year to run it." This is a burden that the states, most of which are already in deep financial trouble, are not likely to embrace with enthusiasm.
The federal government can set up its own exchanges, in theory, but Obamacare stipulates that Washington would then be required to pick up the tab as well. And, as Cannon goes on to point out, "The Obama administration has admitted it doesn't have the money -- and good luck getting any such funding through the GOP-controlled House." And it gets worse. If the federal government is forced to set up an exchange, it faces yet another huge problem. As Sally Pipes and Hal Scherz write, "The text of the law stipulates that only state-based exchanges -- not federally run ones -- may distribute credits and subsidies."
Thus, if a state refuses to set up an exchange, the feds have no real ability to do so either. The states have an opportunity, therefore, to shoot a poison arrow directly into Obamacare's Achilles' heel. Among those who get this is the Governor of Florida. That is why, when Rick Scott announced that his state would not comply with Obamacare's Medicaid mandate, he also noted that Florida would not be setting up any state-run insurance "marketplace": "Floridians are interested in jobs and economic growth, a quality education for their children.… Neither of these major provisions in Obamacare will achieve those goals."
Scott isn't the only governor to balk at moving forward on state-based exchanges. Scott Walker of Wisconsin, Sam Brownback of Kansas, and Mary Fallin of Oklahoma have all pushed back as well. And the momentum seems to be building. In May, Alabama's governor Robert Bentley thwarted his legislature when it tried to create an exchange and Chris Christie vetoed a bill passed by the New Jersey legislature to set one up. In June, after the Supreme Court handed down its decision, Louisiana Governor Bobby Jindal also joined the movement: "Absolutely, we're not implementing the exchanges. We're not implementing Obamacare."
Meanwhile, conservatives in Congress are ramping up an effort to enlist more governors in the cause. Seventy-three senators and representatives have signed a letter to the National Governors Association urging its members to stay in the fight against Obamacare: "As members of the U.S. Congress, we are dedicated to the full repeal of this government takeover of healthcare and we ask you to join us to oppose its implementation." The letter goes on to specifically implore the governors "to oppose any creation of a state health care exchange mandated under the President's discredited health care law."
The letter, whose signatories include Senators DeMint, Lee, Coburn, Graham, Vitter, Paul, Cornyn, Sessions, Rubio, Toomey and Shelby, points out a number of facts that are apparently not well understood by state politicians, including the effect the exchanges will have on their business constituents. "Resisting the implementation of exchanges is good for hiring and investment. The law's employer mandate assesses penalties -- up to $3,000 per employee -- only to businesses who don't satisfy federally-approved health insurance standards and whose employees receive 'premium assistance' through the exchanges."
In other words, a state that declines to set up an exchange will protect the businesses of that state from avoidable and job-killing penalties. This reality has apparently begun to sink in. There has been a noticeable decline in enthusiasm for exchanges among states that had begun work on them shortly after Obamacare passed. North Dakota, New Hampshire, Idaho and South Carolina, to name a few, have abandoned plans to create these insurance "marketplaces." Kaiser Health News reports that, by the end of June, "only 14 states and the District of Columbia have so far passed legislation authorizing the exchanges."
So, even after the Supreme Court's incoherent ruling that Obamacare and its much-reviled mandate are constitutional, there is still hope that the monster can be brought low. If the states simply decline to implement the insurance exchanges, the beast will die. Will Obama and his HHS minions try to avoid this by ignoring the law and try to funnel credits and subsidies through federally created exchanges? Yep. The rule of law, as they have repeatedly demonstrated, means nothing to them. But that's where the voters come in. This won't be a problem if the electorate evicts Obama from the White House in November."
Insurance Exchange
All you conservatives keep screaming that you want less government control , and now when a state run insurance exchange is possible to come into play you oppose it! It is time to get Rid of Parnell and get a governor that is looking out for the best interest of Alaska, and not getting his pockets lined with corporate money
billb
A state run insurance exchange IS govt controlled. I dont think you think these things thru before you click "Save Comment".
Government supplied is not control
The word "control" is just an empty talking point. There are many things the government supplies that it does not control including almost all the infa-structure in this country everyone uses without a thought. The states could not have pulled it off, and thankfully private enterprise does not own the highways and internet.
I will take the government run healthcare with its 6% overhead over the 30% blood money insurance agencies pay themselves on the backs of the most vulnerable.
Calypso,
very interesting.
akguy
who is going to come up with the $10-100m/yr to maintain the exchange? I would say whoever is doing that controls it.
Death Panels
Right-wingnuts-
Add Death Panels to your cut and pastes from Tea Bagger blogs.
"Obamacare" vs the Affordable Care Act
Any time a piece - such as the one copy/pasted above (why not just post the link?) - calls the ACA "obamacare", you can be assured that the article is a screed intended as red meat for the teabaggers, rather than containing anything factual.
It's pretty easy to see what's going on here. As Kate Troll points out, the Governor is more interested in being ideologically "pure" than in helping the people of his state.