Resource Guide on Exchanges
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PAPERS AND OPEDS

LETTERS FROM GOVERNORS TO HHS

 Excerpt:

“The Patient Protection and Affordable Care Act (PPACA) gives states three options in building health insurance exchanges: an exchange built and managed by an individual state subject to federal mandate; a partnership plan requiring the state to perform functions on behalf of the federal government; or a federal exchange developed by the federal government. While the three options differ in who initially builds and operates the exchange, all three options are identical in that they are governed and controlled by federal policy. No matter which option is chosen, Wisconsin taxpayers will not have meaningful control over the health care policies and services sold to Wisconsin residents. If the state option is chosen; however, Wisconsinites face risk from a federal mandate lacking long-term guaranteed funding. In Wisconsin, we have been successful in providing health insurance coverage to over 90 percent of state residents without the creation of an exchange and absent federal regulation. We have a long history of being a leader on health reform issues, and with more guidance and greater state flexibility, our competitive market system would have ensured health insurance coverage to the most vulnerable Wisconsinites without federalization of our market. Unfortunately, operating a state exchange would not provide the flexibility to meet our state’s unique needs or to protect our state’s taxpayers.”

Excerpt:

“HHS is asking states to make final decisions on fiscally and economically significant and pivotal issues without promised federal guidance and rules for issues such as essential health benefits, market reforms, multi-state health insurance plans and more specifics regarding the federally-facilitated exchange. At this point, based on the information we have, states do not have any flexibility to build and manage exchanges in ways that respond to unique needs of their citizens or markets.”

Excerpt:

“Since the ACA was signed into law, the State of Maine, along with several other states, has repeated on a number of occasions and we continue to believe that the law has severe legal problems, is bad policy, and overreaches into the lives and pocketbooks of fellow Americans…We are not going to assist in implementation of this bill in its current form. The ACA is full of federal mandates; as such, even a state-based health insurance exchange is actually controlled by the federal government. In the end, a state exchange puts the burden onto the states and the expense onto our taxpayers without giving the state the authority and flexibility we must have to best meet the needs of the people of Maine…This law robs states of the ability to innovate and find cost-effective solutions that meet the needs of their citizens.   We want meaningful reform, but the ACA masquerades as a free-market idea when in reality it is a stepping-stone to a single-payer system. Maine will not be complicit in the degradation of our nation’s premier health care system.”

Excerpt:

“On the key issues, there is no real operational difference between a federal exchange and a state exchange. A state exchange is nothing more than the state administering the Affordable Care Act with all of the important and critical decisions made by the federal government. The Affordable Care Act is being totally dictated and totally controlled by the federal government. In addition to our concerns that the State of Nebraska would not have any significant control of a state exchange, I am even more concerned about the cost of an exchange…It is simply too expensive to do a state insurance exchange…The bottom line is a state insurance exchange is really controlled by the federal government, and the cost of operating a state insurance exchange is very expensive.”

Excerpt:

“Under the PPACA, the federal government is required to establish exchanges and gave individual states the choice to participate, Yet, as we worked through the process of analyzing the options available to South Carolina, it became abundantly clear that state ‘participation’ was in name only…the law’s state-based exchange programs are not state-based at all. Instead, they simply pass along to the state the burdens of a new and cumbersome bureaucracy. The law fails to give South Carolina any flexibility and decision-making authority that would enable us to truly construct the program in a manner that would offer the most meaningful benefit to our citizens.”

Excerpt:

“I remain concerned with the one-size-fits-all approach and high financial burden imposed on states by this federal mandate…We believe that a well designed, private free-market approach to small business exchanges could be beneficial to small businesses but the regulations promulgated by your administration take those options away.”