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Friday, November 30, 2012

ACA health-insurance exchange is coming no matter what. Who should be in charge?

Posted By on Fri, Nov 30, 2012 at 10:10 AM

Jason Rapert
  • Jason Rapert

We noted yesterday that Rep. Nate Bell has been quoting Christie Herrera of the American Legislative Exchange Council (ALEC). Here’s the advice Bell passed on from her on the health-care front:

Steps states can take to prevent Obamacare's most destructive effects on the health care system
1. Reject state health insurance exchanges.
2. Don't expand Medicaid.
3. Offer an alternative.

We’ve been hearing a lot about #2 on the list, but what about #1 (I won’t hold my breath on #3)? The important thing to understand is that the private health insurance exchanges — a regulated market of health-insurance plans —are going to happen no matter what. Somewhere between 150,000 to 200,000 Arkansans are going to be eligible for a tax credit, on a sliding scale, to help them buy private health insurance. It’s in the Affordable Care Act, it was upheld by the Supreme Court, that ship has sailed. The only question is whether the exchange will be run by the state or the federal government.

So Republicans like Bell must want to give Arkansas control, right? After all, they believe in federalism and distrust the federal government! Not so fast. Defeating Obamacare is now the right’s great lost cause, so conservative activists like Herrera advocate disrupting and sabotaging the new law however they can.

This position leads folks to tie themselves into ideological knots. Earlier this month, Sen. Jason Rapert tweeted, “I am hearing from tons of business owners begging the Legislature to say NO to a state or hybrid health exchange for our state” on the very same day that he tweeted, “Federalism is in crisis in our country. The states have nearly ceded all authority they have under the 10th amendment.” Of course saying no to a state or hybrid exchange means ceding authority to…the Feds!

In his speech earlier this week at the Clinton School of Public Service, Arkansas Surgeon General Joe Thompson advocated for state control of the exchanges. “Arkansans are best served when they pick up the telephone and talk to Arkansans,” he said. “The federal government exchange is going to be built to work for California, Florida, and New York City. The question is, do we want to control our fates or let the federal government control our fates?”

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