Obamacare

Sorry, ObamaCare: Most State Governments Just Aren't That Into You

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It's been two and a half years since the president's health care bill passed, and we're still finding out what's in it. It turns out, for example, that the state-based health insurance exchanges the law was expected to set up may not end up being run by the states.

The Washington Post notes a new report indicating that just 13 states and District of Columbia have officially said they're going to set up their own exchanges. The rest remain either uncommitted or outright opposed. And even those states who have opted in may not actually get their exchanges up and running by October 2013, when enrollment is supposed to start. 

What's the hold up? For one thing, it turns out to be more of a pain in the you-know-what to set up these exchanges than the law's authors expected:

When the law passed, many experts predicted that the vast majority of states would set up their own exchanges. The exchanges are a critical piece of the health law, a resource aimed at helping millions of uninsured Americans find private plans, get government subsidies or gain access to Medicaid, the state-federal program for the poor and disabled.

The experts believed states would want to tailor the exchanges to their own populations. But the task has proved exceedingly complicated. Participating states must set up a call center as well as a Web site that allows people to easily find and understand health plans, in much the way that Orbitz and Travelocity help people find airline flights.

That's right: computer trouble. The policy geniuses behind the law turned out to be a lot better at imagining all sorts of new-fangled web 2.0 socially mediated user engagement tools (or whatever the kids do on the Internet these days) than at actually building and connecting the sorts of complex, interoperable databases that are required to make this thing work. Reason readers were warned about technical problems facing exchange creators, and other issues facing states tasked with setting up exchanges, at least two years ago, but some of the rest of the world is apparently just catching on. 

States are opting out because the law is a mess and it's easier to let the feds handle it. And because they can. Under the law, setting up the exchanges is optional. It's just that any state that declines was told to expect the federal government to step in and run an exchange without any input from the state. That was supposed to be an incentive for states to build and run their own exchanges—or perhaps a threat, for those less inclined to be excited by the Sim Health-like challenge of running their own health insurance exchange.

But it's looking more like an empty threat. In a bit of a head-scratcher, the law's authors kind of forgot to dedicate money to setting up the federal exchanges. They also irritated their own supporters by including langauge saying that the law's subsidies for private insurance can only be accessed through state-based exchanges, which more or less knee-caps the federal exchanges, which are supposed to be the vehicles for the law's insurance subsidies.

Supporters of the law say this has to be a glitch, a mistake. But all signs indicate that it was very much intentional. Every previous version of the law included the same language. And the only statement of intent in the legislative record is by Democratic Sen. Max Baucus, who explained prior to the law's passage that the subsidies were intentionally made available only to states in order to incentivize them to create exchanges. Like much of the law, it doesn't seem to have worked. 

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  1. Maybe the states should rebel, threatening secession and the like.

  2. Why all this gobbledy gook for free healthcare that covers all the uninsured?

    /average Obama supporter.

    The smart ones all tell me Congress will have an Obamacare “round two” that will fix everything in his second term.

  3. Michael Moore still epically retarded:

    Nothing makes the 1 percent angrier than any suggestion that anyone else helped them acquire their beautiful, beautiful cash.

    So I was a little surprised to find out from the New Yorker magazine this week that one of Bain Capital’s very first deals was buying “a small airline that ran military shuttles between Tonopah, Nevada and Las Vegas.”

    [. . .]

    So from the start, Bain Capital had support from the government. We all built that. Just don’t ever mention that in public, or come around asking Mitt and his billionaire friends to kick in a little more so your aunt can pay for her breast cancer treatment or your 5-year-old can have a good kindergarten teacher. That would make them very angry, and you wouldn’t like them when they’re angry.

    Jesus Fucking Christ. That there are people who actually take him seriously yammering on about the 1% (still) while he lives in a fucking mansion with his millions of dollars tells me just how fucked we are.

    1. Roger And Me? You didn’t film that.

    2. “asking Mitt and his billionaire friends to kick in a little more”
      I have no problem with asking. But that really isn’t what he means…

    3. Oh don’t you see what a brilliant device the left have come up with here? “You received something from the government, so now it owns you you have to ‘give back'”. That something can be (shitty) public education by the way. I’ve totally had this used on me.

      1. What’s mind boggling about it is “something from the government” in this case apparently is payment for services rendered.

        1. What’s mind boggling about it is “something from the government” in this case apparently is payment for services rendered.

          I think you mean payment for services half fucking assed.

          1. Probably, but he was talking about Romney’s contractor.

      2. I’ve had that line used on me too. I tell them that I pay more in property taxes than they make in a month, and not a penny of that goes towards my privately educated child, and that they should be thanking me for educating their fucking children on my goddamn dime.

        Shuts them up every time.

        1. I’m guessing they shut up because your face is all bug-eyed like Ian Poulter when you are saying that.

      3. Shitty public education that, unless you were fortunate enough to have parents able to homeschool you or send you elsewhere, you were forced by law to receive.

        1. That book in front of your kid? He didn’t crack that open.

          Jeez. I owe my education to my grandmother making me sit in her private library and read when she kept me over the summers than I do to all the teachers I had combined. Her three decade long collection of National Geographic, Morris Kline books on mathematics, and many non dumbed down history books were the backbone of what I knew of the world before the age of twelve.

    4. So your wealth is tainted forever and everyone has claim on it if you ever invest in a business that has a government for a client? That is utterly daft.

      1. No, your wealth, other property, and even your body are all tainted forever and everyone has claim on it if you ever received any service or money, including refunds of your own taxes, from the government.

        1. And being that the government has meddled with every aspect of our lives from the pillow cases we sleep on to the toothpaste we use to the food we eat to the cars we drive, not a single person, under this argument, can claim to have lived without government support.

          It’s fucking sick.

          1. The sickest thing is that these grasping fucks only use this logic to take from others. You try and take their shit and “that’s mine” will be uttered right quick.

      2. That is utterly daft.

        Consider the source.

  4. “The policy geniuses behind the law turned out to be a lot better at imagining all sorts of new-fangled web 2.0 socially mediated user engagement tools (or whatever the kids do on the Internet these days) than at actually building and connecting the sorts of complex, interoperable databases that are required to make this thing work.”

    They are idea people, man! You cannot expect them to figure out how to actually make it work

    1. Anything is possible if you don’t know what you’re talking about

  5. I am kind of getting a feeling that Mr. Suderman doesn’t believe this was especially well crafted legislation (that we had to pass to know what was in it). Huh, maybe it is just me starting at shadows.

  6. Apparently The Daily Caller has unearthed an old “Kill Whitey!” speech by Obama and they are airing it on Hannity tonight.

    1. October – surprise!

      1. I don’t recall Republicans ever successfully pulling off an October surprise.

        E.g. George Allen revealed some seriously creepy and bizarre passages from Jim Webb’s novels. Webb is a genuinely unhinged dude (who occasionally has really good ideas about things like prison reform), so it’s not as though Allen was wrong to imply that his novels were indicative of the man’s character. Nevertheless, Democrats shrugged it off and said, “well it’s just literature.” If anything, the attack helped push Webb over the top.

        1. Yeah, probably TEAM BLUE will just double down on retard. After all, it’s not like we’ll ever hit Peak Retard.

        2. What about Willie Horton?

          Or did that sink the Great Greek Hope well before October?

          1. This had something to do with it.

            1. How could anyone not vote for that guy?

          2. According to Wikipedia, which confirms what I’ve heard before, Horton as a campaign them started in the primaries with Al Gore. Bush mentioned it in June of 1988. The ads started rolling in September. So, it wasn’t October and it wasn’t a surprise by the time the GOP got ahold of the issue.

            1. Campaign theme, not campaign them.

          3. Yea, I’ve watched the Willie Horton ad. I don’t really see the issue with accurately describing what happened. Maybe they should have just used the eyebrow’s picture…

    2. Kill Whitney?

      1. I thought she was already dead. WAIT A MINUTE.. now it all makes sense.

    3. 2007 “Kill Whitey!” sure is better than Obama delivering it back in the last century.

    4. I’m sure it will get just as much play among the media as Romney’s 47% comments.

  7. “Supporters of the law say this has to be a glitch, a mistake. But all signs indicate that it was very much intentional.”

    The only legislators who vote to pass such a law are idiots, it should come as no aurprise that they wrote it idiotically.

  8. “The policy geniuses behind the law turned out to be a lot better at imagining all sorts of new-fangled web 2.0 socially mediated user engagement tools (or whatever the kids do on the Internet these days) than at actually building and connecting the sorts of complex, interoperable databases that are required to make this thing work.”

    This has a perfect parallel in the rush to transfer medical records to digital form. For years proponents of EMR (electronic medical records) claimed that they would save money and increase efficiency within the hospital, thus improving care and outcomes. In fact, during the debate for Obamacare the admin bragged about the potential cost savings that this law would create because of the new mandates for hospitals to switch to EMR’s.

    Turns out, not so much.

    http://www.nytimes.com/2012/09……html?_r=1

    But others place much of the blame on the federal government for not providing more guidance. Dr. Simborg, for one, said he helped draft regulations in 2007 that would have prevented much of the abuse that now appears to be occurring. But because the government was eager to encourage doctors and hospitals to enter the electronic era, he said, those proposals have largely been ignored.

    “What’s happening is just the problem we feared,” he said.

    RC Dean, laws of unintended consequences, take it away…..

    1. How do these people tie their shoes in the morning? If EMR was such a great idea, wouldn’t somebody have, oh, I don’t know, found a way to make money from it? But the second you mention that, the jeers of “market fundamentalist” tumble out, as though market forces are some kind dirty trick concocted by libertarians to thwart progressivism.

  9. The policy geniuses behind the law turned out to be a lot better at imagining all sorts of new-fangled web 2.0 socially mediated user engagement tools (or whatever the kids do on the Internet these days) than at actually building and connecting the sorts of complex, interoperable databases that are required to make this thing work.

    Quite a few of those policy “geniuses” are likely to be troubled by questions such as the probability of two coin flips coming up heads, especially if one assumes the Democratic lawmakers are the equivalent of the British Labour MPs.

  10. When the law passed, many experts predicted that the vast majority of states would set up their own exchanges[…] The experts believed states would want to tailor the exchanges to their own populations. But the task has proved exceedingly complicated.

    “They promised us jetpacks, Kitty!”

  11. Why’d you kick me?

    Where’s your brain?

    Why’d you kick me?

    I asked you first

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