published Monday, December 3rd, 2012

Smith: The Davy Crockett exchange

By Robin Smith
  • photo
    Robin Smith, former Chairman of the Tennessee Republican Party and congressional candidate.
    File Photo/Chattanooga Times Free Press

The cleverly named Patient Protection and Affordable Care Act signed into law by President Obama in March 2010 will move forward to full implementation by 2014. Meanwhile, the state-driven component is up against a looming deadline.

There are two choices faced by each state: One, whether or not to expand Medicaid coverage, or TennCare here, for the poor. Two, whether to establish and run a health insurance exchange -- that creates a market for those who qualify for the federal subsidy to purchase a minimum health benefit plan -- or to allow the federal government to establish and run the exchange.

Hopefully, no one has forgotten the work undertaken by Gov. Phil Bredesen and the Tennessee General Assembly to make significant cuts to TennCare in order to prevent our state's budget from being consumed by the health program for the poor. Expanding TennCare would be expanding a taxpayer-funded defined-benefit plan that is not adjusted for inflation.

Tennessee appears to have decided against expanding TennCare while contemplating the state exchange. Two of our neighbors, Alabama and Georgia have rejected both options.

The establishment and administration of a health insurance exchange would certainly be best controlled by each state -- if each state actually has control.

The federal government promises to "return" some of your tax dollars to Tennessee in the form of a defined contribution, a fixed amount. This fixed amount of funding will be awarded to people who are uninsured and meet the federally determined criteria of eligibility. This money is used to purchase a minimum-benefit health plan or applied toward the purchase of any so-called bronze, silver, gold or platinum insurance plans approved by the federal government.

The state health exchange, as mandated by the federal law, must also provide Web resources like a cost calculator and a toll-free call center. It must also determine eligibility and enroll participants, determine eligibility for cost-sharing reductions and tax credits, determine whether employer-sponsored insurance is "affordable" (less than 9.5 percent of household income), operate a consumer assistance program, report user and employer data to the U.S. Treasury and generate sufficient revenue to be self-sustaining by 2015. All this is according to Tennessee's Web page about our current state insurance exchange initiative.

Call me jaded, but having the U.S. government graciously "return" some of our tax dollars to Tennessee to fund a federally structured insurance program -- while setting the rules and sending a fixed contribution for a defined benefit that will no doubt increase in price to administer each year -- sounds less than ideal.

Do you remember what the Obama administration and the Democrats in Congress said about health care reform during the president's first term? They said it was to reduce health care costs.

The famed economist Milton Friedman once quipped, "The government solution to a problem is usually as bad as the problem." Indeed.

One of the ACA's architects, MIT economist Jonathan Gruber, initially trumpeted in 2009 Forbes magazine interview that, "young people would save 13 percent and older people 31 percent on their insurance premiums." Dr. Gruber has now reversed course when doing an analysis on the state level.

He has recently changed his tune after conducting a cost-benefit analysis for Colorado, Minnesota and Wisconsin. By 2016, each of these states would see increases in insurance premiums by as much as 19 percent, 29 percent, and 30 percent, respectively. Savings that were touted at the federal level have turned out to be price increases for consumers.

Tennessean Davy Crockett's advice informs our state leaders: "Be sure you are right; then go ahead."

Robin Smith, a consultant at Rivers Edge Alliance, is a wife and mother living in Hixson. She served as chairwoman of the Tennessee Republican Party from 2007 to 2009.

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Ah, keep digging up those famed zingers. They don't substitute for real solutions.

Tell me, do you object to federal tax dollars going to the National Guard too? And that there are some requirements to that? Not that you can actually establish a problem with those requirements, they seem rather sensible to me. Yet you complain that the federal government is being responsible to the citizens by not just hand-waving any problems. Maybe you should remember when that was done with voting rights, even election districts. There is a balance to be struck between sufficient freedom and sufficient accountability. Why do you hate that idea?

But actually, our state leaders do quite believe they are right. Stubbornly so, to the point where they might well drive themselves off a cliff since they know better and won't even listen to any body else. Maybe it'd be more important to be less certain, and more thoughtful.

Or you know, you can complain about Obama listening to your ideas by completely getting hysterical that they're actually being implemented.

December 3, 2012 at 12:26 a.m.
conservative said...

I wouldn't touch it with a ten foot pole. Obamination care will be a moral and financial disaster. Why would a governor share or take the blame for the coming disaster?

Better to let the feds control it and that way Obamination and the Demoncrats get all the blame.

December 3, 2012 at 10:13 a.m.

Good to let us know your priority.

It's not serving the citizens, but rather finding a way to make sure somebody else has the blame.

That's a great attitude.

Also here's a quote:

If I am fool, it is, at least, a doubting one; and I envy no one the certainty of his self-approved wisdom. George Byron

December 3, 2012 at 11:01 a.m.
Rickaroo said...

In the days prior to the passage of Medicare conservatives were making some of the very same end-of-life-as-we-know-it complaints against it that they are now making against Obamacare. Not only did Medicare not wreck the economy, it proved to be an egalitarian, prudent, economically sound health-care policy that has been directly responsible for saving, improving, and extending the lives of millions upon millions of our senior citizens. Medicaid likewise has saved the lives of countless millions of Americans who otherwise would have had to simply die or suffer unduly from neglected illnesses or injuries.

Certainly Medicare and Medicaid both are in need of tweaking but it would be unconscionable and foolish to even think of dismantling them. Private vouchers, the only "solution" to our broken health care system that Republicans have proposed so far, does absolutely nothing to address the runaway costs of health care and would prove to be a wasteful and frivolous government expenditure, as it would be a back-end solution to a problem that desperately needs addressing on the front end.

Republicans/conservatives offer nothing to fix the problem. All they can do is complain about what a "catastrophe" Obamacare will be and try to convince governors to reject it. They say nothing of the millions of people that Obamacare would help and they propose nothing as an alternative plan to help them. All they know how to do is complain and whine and turn a blind eye to the more than 50 million Americans who are not as fortunate as they.

"Let 'em die" is not what any of them will admit to thinking (though Ron Paul pretty much said that very thing in one of the Republican debates, as the cheering audience affirmed his stance by their thunderous applause), but that seems to be their only "solution" to a problem that they really have no interest whatsoever in addressing. After all, Republicans are not known for fixing problems; their main mission in life seems to be to criticize and stand in the way. That's just what conservatives do.

December 3, 2012 at 6:55 p.m.
Facts said...

Amazed at how articulate many of you appear who really seem to know so very little about reality. Economics applies to healthcare, but it's actually government interference and the price controls of government reimbursement that is at the root of the current high cost of health care. When a patient isn't the customer, they don't have to shop for a good price. Example, car and homeowners insurance. Why do you think there's such a competitive market among Geico, Progressive, AllState, etc? They have to meet customer needs at a good price. I know; that didn't come out of the Barack Obama-Saul Olinsky redistribution manual.

December 3, 2012 at 8:46 p.m.

Yeah, that's the ticket, and people actually want to go around shopping for the best price when they need medical care.

Sorry dude, but you have no idea about the reality of medical care or the selection process involved.

When you need it, you damn well need it right then, and can't look around deciding what to do. Even when a person has time to select a doctor, they're often at a loss as to what to look for, or even whether or not they're getting good care. You really don't understand how people deal with their health care needs at all.

Besides, your examples are preposterous, you think that car and homeowner's insurance aren't highly regulated fields too? Or with a ton of bailouts in the event of disasters?

But no, instead of actually solving problems you'd rather pretend you can spew out whatever hate-filled bile-ridden fantasy you've been told to regurgitate as a distraction from the issues. The accuracy of your claims is irrelevant, you just pretend to have the facts.

Riddle me this though, why do countries like France, the UK, Germany, Canada, pay less for overall healthcare, have higher satisfaction, and yet don't succumb to the pretense of a free market?

December 3, 2012 at 10:30 p.m.
Leaf said...

Definitely, let's not do a Tennessee exchange. Not for any political idealogical reasons, but because it's more efficient not to. Why have a state government agency duplicate something that's already being done at the Federal level? That's just inefficient. Plus, insurance is all about spreading risk. The bigger the pool, the better. And let's face it, Tennesseans are less healthy than the average American, so it would be a net gain for us monetarily to just use the Federal plan.

For all these actual reasons, not nebulous emotional reactionary ones, we should not spend the time and money to create a state exchange.

December 7, 2012 at 10:05 a.m.
tnguyengp said...

The government is gambling with our future with this Davy Crockett exchange. Maybe I should send them these Davy Crockett cards for Christmas:

December 7, 2012 at 5 p.m.
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