ObamaCare's Exchanges: The Administration Makes the Rules, States Take the Blame


The Hill reports that state officials are worried that they might be blamed for problems inside ObamaCare's state-run, federally regulated health insurance exchanges:

Federal regulators are writing the rules governing key aspects of the law, including the guidelines to determine who's eligible for subsidies to buy private insurance. 

Those benefits will be delivered through state-based exchanges, however, leaving state officials on the receiving end of angry phone calls if glitches in the law aren't ironed out by 2014.

ObamaCare's health insurance exchanges are set up so that the administration gets to make the rules, but states get to take the blame. This is one of the reasons why I've argued that states, especially those opposing the law in court, ought to think seriously about declining to participate in the exchanges entirely. 

What sort of problems are states anticipating? Here's The Hill, again:

One key shortcoming is found in the law's subsidies for people who don't have access to affordable coverage through their employer. As The Hill first reported in July, the law links the subsidies to the cost of coverage for a single employee. If that coverage is found to be affordable, the individual does not qualify for subsidies in the state health exchanges. 

But the determination is based on the single-employee rate regardless of whether the individual has a spouse and/or children — meaning that someone could end up disqualified from the federal assistance yet unable to afford the family coverage that an employer offers.

"Such an outcome would undermine Maryland's goal of reducing the number of uninsured residents," Maryland Health Benefit Exchange officials wrote in comments to the Department of Health and Human Services that were due Monday. 

Changing that calculation, however, could add as much as $500 billion to ObamaCare's price tag.