Conservatives off the mark in aiming at Obamacare ‘exchanges’

Here is my Sunday column ...

Conservative Republicans and tea party types, eager to the very end to repel Obamacare, celebrated this week’s legislative defeat of a plan to establish a health care exchange – the Affordable Care Act’s “marketplace” – in Michigan.
What these diehards fail to understand, in their zeal to hold Obamacare at bay, is that they have undercut the most conservative aspect of the ACA.
As these purists mounted the barricades, all they accomplished is to impart self-inflicted wounds on the state of Michigan.

The online exchanges are an idea borne more than 20 years ago within conservative think tanks, such as the Heritage Foundation, to create a marketplace where the uninsured could shop for health care coverage offered by various private insurers.
The concept was this: Rather than the government establishing a bureaucracy to provide medical services for our nation’s shamefully high number of uninsured, let the private sector handle the problem.
Make the insurers compete for that huge pool of millions of new customers and give the uninsured tax breaks to help them afford their individual policies.

If that’s not a conservative approach to the problem, what is?

Yet, Michigan’s anti-Obama zealots dug in their heels and the GOP-controlled House Health Policy Committee this past week flat-lined the bill that would have established a state exchange.
The result? The state will still have an exchange, but it will consist of a cookie-cutter version spawned by the feds that will grant Michigan less flexibility to customize their online marketplace to address the state’s needs and dynamics.
Is that a victory worth celebrating?

Consider this: The losers in this political battle were insurance companies, much of the business community and Gov. Snyder, all of whom had advocated for a system designed by our home state.
Michigan is certainly not alone in this last-ditch revolt against Obamacare. One estimate indicates that as many as 30 states will foolishly follow the same path.
It’s important to note that the defeat in the Michigan House came just days after the federal Department of Health and Human Services issued new ACA rules that grant the states more maneuverability than expected to tailor their state exchanges.

Families USA, a nonprofit group that advocates for consumer-friendly health care reforms, expressed dismay that the state Legislature “walked away” from the chance to create a Michigan-made exchange.
“This was a wonderful opportunity for your state to take advantage of an exchange. We don’t understand why Michigan would reject funding to develop something that meets their needs,” said Claire McAndrew, a senior health policy analyst for Families USA.

Under the exchange system, each consumer will choose from price-adjusted health plans available in four categories, ranging from the bronze tier, which requires the insured to pay 40 percent of annual health care costs in deductibles and co-pays, up through silver and gold categories and topping out at the platinum level, where the policy holder pays higher premiums but just 10 percent of out-of-pocket costs.
Contrary to tea party propaganda, this is not free health care. The means-tested federal tax subsidies simply ensure that no uninsured household pays an exorbitant amount for insurance.
Open enrollment will begin on Oct. 1, 2013, and the exchanges will power up on Jan. 1, 2014.

Gov. Snyder has rightly compared the exchange process to the Travelocity website that gives travelers numerous options when planning a trip.
Overall, the marketplace exchanges, the centerpiece of the entire reform plan, are based on the system offered to federal employees – from White House janitors to senators – that allows them to shop for a policy that fits their needs. To view this effective and highly transparent system, go online to the website opm.gov. Click on “insurance programs” followed by “how do I find a plan,” stick with the health insurance information, click on “plan comparison tool” and then present yourself as a hypothetical federal employee.

McAndrew said the ill-informed debate in Michigan relied upon several red herrings: the exchange does not transform states into a subsidiary of Obamacare; the 2 to 3 percent assessment levied on each policy will pay for website operations and state regulators on the lookout for insurance fraud and scams; the exchange presents no long-term liabilities to the state; and the process will have no impact on the state budget.
Opponents of a state exchange appealed to politicians’ fears, asserting that state legislators will become the “fall guys” when Obamacare flops. One woman who testified at the House committee hearing called the ACA a “horrifying path to financial ruin” and told the lawmakers, “You will simply be compliant in implementing the worst law ever.”

Now, Snyder will attempt to repair the damage by piecing together a “partnership exchange” that allows for a state-fed hybrid. Fortunately, federal money will still finance the start-up costs.
Meanwhile, those who snuffed out the state exchange need to come to grips with Obamacare reality – and I’m not referring only to the fact that repeal in Congress is no longer a viable option.
The ACA is not a government takeover, it is not socialized medicine, it is not some new welfare program for moochers.

The reform law is multi-layered and complex, so much so that it offers conservatives several areas in which to propose future amendments, such as the requirement that all employers with more than 50 employees must offer their workers a federally certified health insurance plan.
But to take a stand against the most conservative, market-driven aspect of the ACA is clearly off the mark.

I wonder: If you shoot yourself in the foot, is that covered by Obamacare?