GOP-led states start warming up to health care law

In this May 16, 2012 photo, Florida Gov. Rick Scott speaks in Fort Laud­erdale, Fla. From the South to the heart­land, cracks are appear­ing in the once-solid wall of Repub­li­can resis­tance to Pres­i­dent Barack Obama’s health care law. Gov. Scott, one of the most vis­i­ble oppo­nents of Obama’s over­haul, now says “I can get to yes, I want to get to yes.” (Asso­ci­ated Press File | J. Pat Carter)

RICARDO ALONSO-ZALDIVAR

Asso­ci­ated Press

WASHINGTON — From the South to the heart­land, cracks are appear­ing in the once-solid wall of Repub­li­can resis­tance to Pres­i­dent Barack Obama’s health care law.

Ahead of a fed­eral dead­line Fri­day for states to declare their inten­tions, Asso­ci­ated Press reporters inter­viewed gov­er­nors and state offi­cials around the coun­try, find­ing sur­pris­ing open­ness to the changes in some cases. Oppo­si­tion per­sists in oth­ers, and there is a wide­spread, urgent desire for answers on key unre­solved details.

The law that Repub­li­cans have derided as “Oba­macare” was devised in Wash­ing­ton, but it’s in the states that Amer­i­cans will find out if it works, deliv­er­ing promised cov­er­age to more than 30 mil­lion unin­sured people.

States have a major role to play in two of the overhaul’s main com­po­nents: new online insur­ance mar­kets for indi­vid­u­als and small busi­nesses to shop for sub­si­dized pri­vate cov­er­age, and an expanded Med­ic­aid pro­gram for low-income people.

Fri­day is the day states must declare if they’ll build the new insur­ance mar­kets, called exchanges, or let Wash­ing­ton do it for them. States can also opt for a part­ner­ship with the feds to run their exchanges, and they have until Feb­ru­ary to decide on that option.

Some glimpses of grudg­ing accep­tance across a shift­ing scene:

— One of the most vis­i­ble oppo­nents of Obama’s over­haul, Florida Repub­li­can Gov. Rick Scott, now says “if I can get to ‘yes,’ I want to get to ‘yes.’”

Florida was a leader in the failed effort to over­turn the law in the Supreme Court, and a group formed by Scott ran TV ads oppos­ing it before it passed Con­gress. But the gov­er­nor told the AP this week he wants to nego­ti­ate with the fed­eral gov­ern­ment to try to help the nearly 4 mil­lion unin­sured peo­ple in his state.

— In Iowa, GOP Gov. Terry Branstad says he is post­pon­ing a deci­sion because Wash­ing­ton has not pro­vided enough infor­ma­tion about key details. But his spokesman, Tim Albrecht, said Iowa is explor­ing a part­ner­ship exchange that could include sev­eral states. Albrecht said they’re con­fi­dent they can get to a state option if needed.

Ohio, like Florida and Iowa a state Obama car­ried in the elec­tion, is lean­ing toward a part­ner­ship with the fed­eral gov­ern­ment despite GOP offi­cials’ con­tin­ued mis­giv­ings about the law.

— In Mis­sis­sippi, Repub­li­can insur­ance com­mis­sioner Mike Chaney for­mally noti­fied Wash­ing­ton on Wednes­day that his agency will pro­ceed with a state-run exchange, dis­ap­point­ing GOP Gov. Phil Bryant, who remains staunchly opposed to Obama’s law.

Chaney, too, says he wishes the law could be repealed, but he wor­ries that “if you default to the fed­eral gov­ern­ment, you for­ever give the keys to the state’s health insur­ance mar­ket to the fed­eral government.”

As for try­ing to fight the feds, Chaney observed: “We tried that 150 years ago in the South, and it doesn’t work.”

— In New Mex­ico, the admin­is­tra­tion of Repub­li­can Gov. Susana Mar­tinez had been qui­etly work­ing to put the law into place as the polit­i­cal storm swirled. With a fifth of its pop­u­la­tion unin­sured, the state is plan­ning to run its own exchange.

“The party is over. The oppo­si­tion is over,” New Mex­ico Human Ser­vices Sec­re­tary Sidonie Squier told the AP. “What­ever states didn’t think they were going to do it, I think they’re going to have to do it whether they like it or not. It’s a done deal now.”

Pol­icy experts in Wash­ing­ton are notic­ing the shift.

“I think it’s a very prac­ti­cal deci­sion for states now,” said Alan Weil, exec­u­tive direc­tor of the non­par­ti­san National Acad­emy for State Health Pol­icy. “We are going to have a sig­nif­i­cant num­ber of states run­ning their own exchanges, a sig­nif­i­cant num­ber where the fed­eral gov­ern­ment is run­ning the exchange, and a sig­nif­i­cant num­ber of part­ner­ships. The bot­tom line is we are going to have to fig­ure out how to make all three mod­els work.”

Although the pub­lic remains divided about the health care law, the idea of states run­ning the new insur­ance mar­kets is pop­u­lar, espe­cially with Repub­li­cans and polit­i­cal inde­pen­dents. A recent AP poll found that 63 per­cent of Amer­i­cans would pre­fer states to run the exchanges, with 32 per­cent favor­ing fed­eral control.

The break­down among Repub­li­cans was 81–17 in favor of state con­trol, while inde­pen­dents lined up 65–28 for states tak­ing the lead. Democ­rats were almost evenly divided, with a slim major­ity favor­ing state control.

There are sev­eral poten­tial ben­e­fits to a state oper­at­ing its own exchange, experts say.

The biggest advan­tage may be that states would be more closely involved in coor­di­nat­ing between the exchanges and Med­ic­aid pro­grams. Because many peo­ple are going to be going back and forth between Med­ic­aid and pri­vate cov­er­age in the exchanges, states would prob­a­bly be bet­ter served by a hands-on role.

States can also decide whether to allow open access to all insur­ers, or work only with a panel of pre-screened com­pa­nies that meet cer­tain requirements.

Also, the exchanges will offer cov­er­age to peo­ple buy­ing in the indi­vid­ual and small busi­ness mar­kets, areas that states have tra­di­tion­ally reg­u­lated. With­out a state-run exchange, states could be deal­ing their own reg­u­la­tors out of the equa­tion, as Mississippi’s insur­ance com­mis­sioner Chaney noted.

When the leg­is­la­tion was being con­sid­ered in Con­gress, Democ­rats in the House wanted to have a national exchange admin­is­tered by the fed­eral gov­ern­ment. But they lost the argu­ment with their cen­trist Demo­c­ra­tic coun­ter­parts in the Sen­ate, who wanted state exchanges in order to pre­serve a state role.

Despite signs of move­ment toward going along with imple­men­ta­tion of the over­haul, some major Republican-led states are hold­ing fast. In Texas, the elec­tion results did not change any of the oppo­si­tion to expand­ing Med­ic­aid or to set­ting up insur­ance exchanges. The same holds for Louisiana, South Car­olina, Mis­souri, Kansas and others.

“Adding more peo­ple to an already sink­ing ship with money that is either being bor­rowed from China or com­ing out of tax­pay­ers’ pock­ets is bad pol­icy and bad for Tex­ans,” said Cather­ine Fra­zier, spokes­woman for Gov. Rick Perry. Twenty-seven per­cent of that state’s res­i­dents are unin­sured, the largest per­cent­age for any state.

Many Repub­li­can state offi­cials com­plain that the Obama admin­is­tra­tion sim­ply hasn’t given them enough infor­ma­tion. Indeed, sev­eral major reg­u­la­tions affect­ing the exchanges have yet to be released. But that doesn’t seem to have stopped states that made an early deci­sion to proceed.

Vir­ginia, a Republican-led state that voted for Obama on Nov. 6 and also elected a Demo­c­ra­tic U.S. sen­a­tor, is among those default­ing to Wash­ing­ton. But a spokesman for Gov. Bob McDon­nell said things may change.

“This is not a final deci­sion,” said Jeff Cald­well. “The fact is, states still need far more infor­ma­tion before any final deci­sions can be made on behalf of Virginia’s tax­pay­ers.” The final call, he added, belongs to the state Legislature.

Posted by AP News on Nov 15 2012. You can follow any responses to this entry through the RSS Feed. Comments can be made below.