South Dakota conservatives were pleased when Governor Dennis Daugaard decided he would keep his hands clean of one element of the Patient Protection and Affordable Care Act and let the federal government run the health insurance exchange requires every state to offer its citizens. The only practical reason the Governor cites is cost: he says running a state exchange would cost us $6.3 million to $7.7 million, in the ballpark of what he spends on French cheese subsidies and out-of-state headhunters.
Review how health insurance exchanges work in this Ezra Klein column. The health insurance industry says the exchanges will work better if they are run by the states:
The idea is that states, which have traditionally regulated the insurance industry, are better positioned to oversee the marketplaces, websites where people will shop for health coverage and access federal tax subisides to purchase it. That's a perspective shared by insurers.
“We’ve always been supportive of having state-based health exchanges,” Alissa Fox, senior vice president at the Blue Cross/Blue Shield Association’s office of policy and representation, said at a briefing with reporters Thursday in Washington, D.C. “We’re going to make that a priority.”
The position is shared by America's Health Insurance Plans (AHIP), the largest trade organization representing the health insurance industry. “States are in the best position to run exchanges because they have the experience, infrastructure, and local market knowledge to ensure exchanges are meeting the needs to consumers and employers in the state," Robert Zirkelbach, an AHIP spokesman, said in an email [Dylan Scott, "States Will Be Pushed to Take Control of Health Exchanges," Governing, 2013.02.08].
Governor Daugaard wants to keep the authority to regulate the federal exchange's activities in South Dakota, but that doesn't include the advantages a state exchange has in using existing infrastructure and customizing the program and its marketing to local folks, as the feds are warning similarly balky Wisconsin.
I can understand South Dakota Republicans' not wanting to spend money to make President Barack Obama's signature legislation work better. But a few years from now, when the PPACA is producing better results for the residents of Minnesota and Colorado than for South Dakotans, remember that we have no one but ourselves to blame.
They won't do anything Cory because there is NOTHING and I mean NOTHING that they would do to make Obama look good
I think that it has more to do with their own politics than it does anything about Obama. They can't be seen to support anything to do with the ACA, even though they know it is inevitable. They will cut off their noses in spite of their faces to save their asses. The propaganda against the ACA was so successful that they are now backed into the corner and can't walk away from it.
All this sort of reminds me of the years of debate over whether the state should accept responsibility for enforcing federal environmental programs. For years the dumb s### Republicans couldn't seem to understand why it was in South Dakota's interest to have local people in control. (Again, "local control" is a hollow catch phrase for the power brokers.) Finally, the dumb s### business community figured it out it was costing them much more and started lobbying for South Dakota to accept some responsibility for environmental protection, and, of course, the dumb s### Republicans fell in line. It will take a couple years but the dumb s### Republicans will figure it out.
Why not let the Nine Tribes set up exchanges? They are equal to the states.
Barry, you're right: it's very political. I wouldn't think they'd feel that cornered by their own propaganda, though. Does Governor Kasich of Ohio have any less to lose in accepting the Medicaid expansion than Daugaard does?
I'm sure, like Don, that the GOP will eventually figure it out. The math is pretty simple. But will it really take Daugaard and the GOP another year? For Pete's sake, do it now, and let everyone simmer down and enjoy the benefits for a year before the 2014 primary. It's also the best way to serve the citizens of South Dakota.
"South Dakota conservatives were pleased when Governor Dennis Daugaard decided he would keep his hands clean of one element of the Patient Protection and Affordable Care Act and let the federal government run the health insurance exchange requires every state to offer its citizens."
Not true, conservatives don't want "any" insurance exchange...federal or state.
Tangentially related. No one knows what it costs to provide hospital services.
This comment sums up health care situation pretty well.
Leaving federal money on the table isn't politics, it is partisanship that hurts most South Dakotans even as it appeals to ignorant, braindead partisans.
SD missed transportation funding because of such nonsense and currently has $12 Million in limbo.
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