Should States Refuse to Implement ObamaCare's Health Insurance Exchanges?


Meet me in Saint Loo-ey?

Whether or not to follow through with ObamaCare's rate review regulations isn't the only tough decision states face about whether to follow the law's rules or let the federal government do it for them. States must make a similarly unpleasant choice when it comes to the law's health insurance exchanges. Via the St. Louis Post-Dispatch

One of the linchpins of the federal health care law passed last year is a requirement that each state establish an insurance exchange — a marketplace where individuals and small businesses can compare and buy private insurance plans.

The federal government will provide states with startup money to establish exchanges, which must be open for business by 2014. If a state declines to start one, the federal government can step in and do it.

With a January 2013 deadline to have an exchange plan ready, lawmakers in Missouri — particularly conservatives who have been outspoken in opposing the health care law — face a difficult proposition: set up the health care plan many of them oppose or do nothing and invite even more federal intervention.

"There really isn't much choice," said state Rep. Chris Molendorp, R-Raymore, who this year sponsored a bill to create an exchange in Missouri. "If we don't act, the federal government will, and that's the last thing Missourians want."

That's an understandable sentiment. But it may not be the best strategy. As I argued in March, states whose legislators oppose last year's health care law have a number of reasons to refuse to participate in implementing its requirements, particularly when it comes to the exchanges. For one thing, it's better policy: States authorities who follow the federal government's rules won't have much flexibility to set up their exchanges as they see fit. It's also better politics: Refusing to play ball with the federal government ensures that the federal government will have to take responsibility for the complex details of the law's implementation. Given that Missouri's residents voted overwhelmingly last year to reject one of ObamaCare's key features, the individual mandate to purchase health insurance, it's clear enough where the state's voters stand.

Finally, there's the constitutional question: Shouldn't states currently challenging the law's constitutionality—like Missouri—steer clear of implementing it? 

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  1. Push comes to shove, the states will cave. They always do when faced with the devious machinations of their federal overlords.

    1. Well duh, all that grant money for roads and stuff like that.

  2. This is why there needs to be a “fast track” to the Supreme Court when states take the feds to court.

    Hell, the states created the Supreme Court. They shouldn’t have to dither for years when everyone and their mother knows that the case will ultimately be decided by the Supremes.

    1. This is why the States need to start deciding these things in their own State Supreme Courts. And if the State finds that the Fed is attempting to exercise a power not granted to it by the Constitution, then they shouldn’t even show up in Federal Court.

      If the Feds are so busy locking people up for buying medicines that have been legalized at the state level, they won’t have much time locking up people for buying the wrong kind of insurance.

  3. Yes.

  4. “there’s the constitutional question: Shouldn’t states currently challenging the law’s constitutionality?like Missouri?steer clear of implementing it? ”

    Begging for snark.

  5. “Should States Refuse to Implement ObamaCare’s Health Insurance Exchanges?”

    Yes, next question.

    1. “Finally, there’s the constitutional question: Shouldn’t states currently challenging the law’s constitutionality?like Missouri?steer clear of implementing it?”

      Also yes, next question?

  6. , I paid $32.67 for a XBOX 360 and my mom got a 17 inch Toshibalaptop for $94.83 being delivered to our house tomorrow by fedex. I will never again pay expensive retail prices at stores.I even sold a 46 inch HDTV to my boss for $650 and it only cost me $52.78 to get. Here is the website we using to get all this stuff, BuzzSave.com


      1. Say, I could have an Xbox 360 in every room in my house at those prices! Can I also get several PS3s so I can play online with my dad and brother?

      2. Console games are for chimps, pirates with hooks on their hands, and people missing fingers. Console controllers are abominations, as are those who use them.

        1. Yes, yes, noted. But one in each room!

          Speaking of PCs and consoles, I strongly suspect that Microsoft has plans within plans within plans for using the Kinect as an interface for Windows systems. Obviously, that could extend to gaming, but I bet it could be pretty useful for other, non-gaming applications.

          I may return to some PC gaming (not counting some old games that I play on occasion) when Diablo III comes out.

          1. Or Borderlands II (they might call it Borderworlds is a rumor as well).

            I just got The Witcher 2 but haven’t even had a chance to try it yet. Maybe this weekend.

        2. I agree fully. Plus, they ruined the RPG genre.

          1. I miss the variety of game styles we once had. Where are games like, say, Wing Commander or the old strategic games? I still play Star Trek Armada II on occasion, which is a pretty cool, if dated, game.

            1. I just replayed the old Fallouts for the billionth time. I think I’ll do Baldur’s Gate again, or maybe Planescape. Everything now is all flashy and shitty.

              Fuck, we’re old.

              1. Baldur’s Gate was pretty tedious. I prefer my RPGs to be all kill, kill, kill, like Borderlands or Diablo. Which is why I can’t wait for Diablo III.

                1. Diablo is about killing, that’s for sure. But in a good way.

                2. You guys inspired that South Park episode, didn’t you.

                3. How about some love for the Commodore 64 and great games like Infernal Runner and Below The Root?

                  1. Or for mainframe games like Colossal Cave Adventure or ASCII Star Trek?

                  2. Below the Root! I was trying to think of what that was called just the other day. That game was awesome when I was a kid.

                    1. I will always have a warm spot in my heart for Trade Wars.

                    2. I think I played that one, but maybe under a different name.

  7. Off topic, but ABC News is reporting that four states have already proposed “Caylee’s Laws” in response to the Casey Anthony verdict. The sad parade of Laws with Names and politicians trying to profit from tragedies involving children.

    1. Making what illegal? I assume that murdering kids is a felony in most states already, except maybe in the more progressive jurisdictions.

    2. Please tell us what these genius lawmakers came up with. I’m sure it’s both moronic and unconstitutional.

      1. I think my wife said something about a Florida proposal yesterday, now that you mention it. Maybe making it a felony to not report a missing kid for a month or something? That’s not entirely insane, as such laws go, I guess. Haven’t really though about it, and I could be misremembering.

        1. Just two days after a Florida jury found Casey Anthony not guilty of murdering her 2-year old daughter Caylee, four states are drafting legislation being referred to as “Caylee’s Law,” which would tighten requirements on missing persons reports.

        2. “Well, officer, I was just enjoying my 32nd day of peace and quiet whant I realized that Joey’s summer camp didn’t start until August.”

          1. I’d have convicted the psycho-slut on that fact alone. Right, just misplaced the baby.

  8. Tread carefully here… if you say “hells yeah, states should be able to set their own policy”, a Tony-like creature will pop up and accuse you of pining for the days of being able to sip mint juleps while your farmhands whip your niggers on the plantation.

    1. Hey, if we can force doctors, nurses, engineers and such in the healthcare industry to work for us at rates dictated by the State, what makes darkies think they can escape the next round of compulsion?

      1. Commerce Clause powers, activate!

  9. Should States Refuse to Implement ObamaCare’s Health Insurance Exchanges?

    Should States refuse to obey the Fugitive Slave Act of 1850?

  10. It would be interesting to see what kind of insurance exchanges the federal government sets up.

    What aspects of the policies available will be immediately visible to customers, for instance?

  11. The only correct answer is “Fuck, yes, they have that right”.

    The Commerce Clause-suckers will, of course, disagree.

  12. The sign in that photo is gold.

    I am curious about what category the other 319,113 people in St Louis fall into, however. {Population figure – Wikipedia]

    1. We’ve fallen to below 300k, Aresen.

      1. For Wikipedia, any figure within +/- 50% is considered sufficiently accurate.

  13. If you want to make yourself ill, read the comments to that story. Yes, there are people out there like that.

  14. Starting this year your child (or children) cannot be denied coverage simply because they have a pre-existing health condition. If you don’t have insurance for you and your children search “Penny Health” online they are the best.

  15. I extremely disagree with the mandatory healthcare plan, simply because it’s mandatory. That’s crap! So whats next if the federal system believes that a person buying a car will help the economy it’s going to become a law everyone must buy a car?

  16. sure, the states should refuse and we can all get ready for another civil war!

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