To the Editor:
No sooner had President Obama won re-election, when the Department of Health and Human Services mandated, under the Affordable Care Act (Obamacare), that states must indicate by Friday, Nov. 16 if they plan to set up a state-run exchange, which is essentially a marketplace for people and businesses to shop for insurance. If states don't set up their own exchange, whether along or in federal partnership, then the federal government will step in and design an exchange.
On the mandated date of Nov. 16, that Health and Human Services Secretary Kathleen Sebelius sent a letter to Republican governors that extended the deadline to Dec. 14 for states to declare how they plan to set up state-based health exchanges mandated by the Affordable Care Act. The move seems a cynical one, as it will give the Obama administration, through the mainstream news media, more time to blast Republican governors as uncaring for not caring about the health care of the poor in their states.
States will also have to decide whether to implement Obamacare's massive expansion of Medicaid. The suggested expansion would open Medicaid to adults younger than 67 with an income of less than 133 percent of the federal poverty level, which would be $14,856 for individuals and $30,657 for a family of four. The federal government would pay 100 percent of the cost of services for new enrollees for the first three years, but that eventually would drop to 90 percent.
Alabama Governor Robert Bentley, a physician, will neither set up a state-run exchange or expand Medicaid under the federal healthcare overhaul, estimating that the cost to operate an exchange in 2015 would range between $34 million and $49.7 million, money his state doesn't have. In Bentley's words: "I will not expand Medicaid as it exists under the current structure because it is broken. We just cannot afford it. The people of America cannot afford it."
Some conservatives might find the arguments for exchanges made by proponents of Obamacare appealing, that it is much better from a states' right point of view to set up state-based exchanges than to let the feds come in and do it themselves, but how wrong they are! Allowing states to be deputized as instruments of federal policy is just as bad as bowing to federal commandeering of state agencies.
As to the federal government being allowed to command states or their officials to do anything, this was settled in two modern commandeering cases, New York v. United States (1992) and Printz v. United States (1997). However, it is increasingly clear that the choice states must make is not really free, for states that don't comply with the federal program are taxed.
At least 17 states and the District of Columbus are on track to set up their own exchanges, which would result in important decisions being made in Washington, D.C. instead of by the individual themselves. States deciding to set up their own exchanges have until Dec.13 to submit details to the the federal government. Exchanges would begin operating in 2014.
Many states are refusing to set up exchanges questioning the legality of the process. At least 14 states have statutes or constitutional amendments forbidding state employees to participate in exchange functions: Alabama, Arizona, Georgia, Idaho, Indiana, Kansas, Louisiana, Missouri, Montana, Ohio, Oklahoma,Tennessee, Utah, and Virginia.
Michael F. Cannon, director of health policy studies at the Cato Institute, believes that states should respond with a resounding 'no' to creating Obamacare health-insurance "exchanges" or implementing the massive expansion of Medicaid. State-created exchanges would mean higher taxes, fewer jobs, and less protection of religious freedom. States would be better off defaulting to a federal exchange.
Cannon likewise views Medicaid expansion as too costly and risky a proposition. Republican Governors Association chairman Bob McDonnell (R.,Va.) agrees with Michael Cannon, and will implement neither provision in Virginia.
Arguments cited by Cannon against creating exchanges include:
1. States are under no obligation to create one.
2. Operating an Obamacare exchange would be illegal in 14 states.
3. Each exchange would cost its state an estimated $10 to $100 million per year, necessitating tax increases.
4. The November 16 deadline is no more real that the "deadlines" for other measures.
5. States can always create an exchange later if they choose.
6. A state-created exchange is not a state-controlled exchange. All exchanges will be controlled by Washington.
7. Washington offered no funds for federal "fallback" exchanges, so Washington may not be able to impose Exchanges on states at all.
8. The Obama administration has yet to provide crucial information states need to make informed decisions.
9. Creating an exchange sets up state officials to take the blame when Obamacare increases insurance premiums and denies care to the sick.
10. Creating an exchange would assist in creating a "public option" that would drive domestic-health-insurance carriers out of business.
11. Obamacare remains unpopular, with only 38 percent public support.
12. If all the states declined to implement exchanges, federal deficits would fall by roughly $700 billion over 10 years.
If enough states reaffirm their opposition to both implementing exchanges and expanding Medicaid, it would send a clear signal to all our elected leaders in Washington that the health care bill should be changed. As such Congress would have no choice but to reopen Obamacare because it would be difficult to go forward.
What would be so awful if states opting out of setting up exchanges allowed the feds to set up one instead? The government would then have to pay for the exchanges and be accountable for the results. This might provide leverage for rolling back some of Obamacare.
Under Governor Quinn the Illinois exchange mandate is assured, as will be the decision to implement Obamacare's massive expansion of Medicaid.
According to the CATO Institute, expanding Medicaid will cost individual states up to $53 billion over the first 10 years.
Look out for more tax increases as Illinois slips further into unsustainable and irrevocable debt!
Nancy J. Thorner
Lake Bluff, Ill.