It has been
nearly 1,000 days since President Obama signed his health care bill into law.
With the Supreme Court upholding much of the law earlier this year and the
political situation in Washington staying the same following the election, the
administration will have free reign to implement the President’s vision for
health care.
I vigorously
opposed the bill because I believed it would fail to deal with our biggest
health care problem: rising costs. Indeed, the Congressional Budget Office
could not back up the President’s claims that the bill would make health care
less expensive in the foreseeable future. For many people, their premium is
already going up.
This week,
the Associated Press reported that insurers will be charging a new $63 fee in
the coming year. When Obamacare was being considered this was just one of the
many fees and charges hidden from consumers. Taxes will be assessed on
insurers, medical device manufacturers and pharmaceutical companies but the
real people footing the bill will be patients.
The taxes are
all set to be collected, but Obamacare’s benefits aren’t quite ready for
primetime yet. The centerpiece of the law is the establishment of health care
exchanges in the 50 states. Exchanges could be a good idea, if they were truly
an easy way for insurers to offer plans and for consumers to have real choices.
The law gives
states a choice about whether to create and operate the insurance exchange
within their borders. States can also choose to “partner” with the federal
government to create an exchange or leave the responsibility completely up to
Washington.
Republicans
are typically the party that promotes federalism, so it may be initially
confusing to find that many Republican governors have decided to let the
federal government run the exchange in their state. In fact, this week Governor
Tom Corbett announced that Pennsylvania would elect not to create a state-based
exchange.
There are
some fundamental problems that make it unwise for a state to create one of
these exchanges on behalf of the federal government. First of all, the rules
aren’t actually written yet. The Department of Health and Human Services
avoided putting out any detailed regulations governing state-based exchanges
until after the election.
Throughout
this year, governors and other state officials from both parties and from
across the country wrote detailed letters to Health and Human Services
Secretary Sebelius asking for information. Energy and Commerce Committee
Chairman Fred Upton (R-MI) and I also wrote the Secretary asking her to reply
promptly. Some letters elicited no response and others were barely
acknowledged. Important questions remain unanswered.
Secondly,
even now, the guidance from HHS is not enough for states to determine how much
it would cost to set up an exchange. These insurance marketplaces have to be up
and running by September 30, 2013. With the rules still largely undefined,
states would be starting a race without knowing what the track looks like or
whether they have enough gasoline to get across the finish line.
Finally, even
with the little guidance that is out there it is evident
that states will not be in the driver seat. How these exchanges will be
structured will be determined almost completely by bureaucrats in Washington.
At this time,
only 14 states have elected to run their own exchange. Twenty-four states have
decided to leave it up to the federal government. It makes perfect sense. The
“choices” states will be able to make in setting up an exchange are largely
illusory.
Because the
federal government hasn’t been doing their job in providing guidance, states
are reluctant to help share the burden. HHS did not anticipate running so many
exchanges in so many states. The President’s health plan simply won’t work
without these marketplaces. They will be the only way for individuals to
reliably purchase insurance that meets government requirements and avoid new
tax penalties. The clock is ticking, and there is no telling whether Obamacare
will be ready.
U.S. Rep. Joe Pitts is a Republican who represents Pennsylvania's 16th Congressional District.
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