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The Corner

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Obamacare: Still Unpopular, Still a Mess



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Say it ain’t so! Obamacare is running into trouble at the state level. From The Hill:

The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems.

The exchanges were designed as the centerpiece of President Obama’s signature law, and are intended to make buying health insurance comparable to booking a flight or finding a compatible partner on Match.com.

Sixteen states — most of them governed by Republicans — have said they will not set up their own systems, forcing the federal government to come up with one instead.

Another five states said they want a federal-state partnership, while four others are considering partnerships.

It’s a situation no one anticipated when the Affordable Care Act was written. The law assumed states would create and operate their own exchanges, and set aside billions in grants for that purpose.

Why did the law assume that? Because, as Ramesh Ponnuru wrote back in October, “The law’s supporters . . . expected the health-care law to become more popular over time.” T’was ever thus, for blind optimism is Obamacare’s founding principle: If people understand it, they’ll like it; if Obama makes just one more speech about it, they’ll like it; if Congress passes it, they’ll like it; if HHS spends millions of dollars promoting it, they’ll like it; if the states are forced to implement it, they’ll like it. And so on and so forth. And yet . . .

Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama’s Health and Human Services Department can’t simply take a system off the shelf as a one-size-fits-all fail-safe.

“You can’t simply deploy one federal exchange across the board,” said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

“Each state is different — their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state.”

Gee, it’s almost as if the United States is a big, diverse federal republic — full of semi-autonomous states with differing laws, governments, markets, and populations — and thus a one-size-fits-all federal solution isn’t the best way to fix things. If only there were some people in America who had made that case from the beginning.



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