The nation's Republican governors and Republican-controlled legislatures have tried mightily to kill or delay implementation of the Affordable Care Act since it was passed two-and-a-half years ago, never mind its great value for strengthening secure, comprehensive and affordable care for all Americans.
Democratic governors began moving more than a year ago to set up the state insurance exchanges required by the ACA to provide affordable flat-rate insurance for those who need it. But Republican governors filed or joined lawsuits challenging the ACA's constitutionality. When the U.S. Supreme Court upheld the new ACA in June, they continued to defer steps to implement the health reform act in the futile hope that Mitt Romney and a new GOP majority in the Senate would dismantle it.
Now, GOP governors are complaining that they have to wait on the Obama administration to answer their newly posed questions about how to implement the law, which is to take full effect in January 2014.
Give us a break. It's time they started moving forward.
Tennessee Gov. Bill Haslam, unfortunately, remains part of the whiner brigade. Taking a cue from the strategy devised last week at the Republican Governors Association annual meeting in Las Vegas, he claimed Monday, like several of his peers, that he now lacks needed information from the White House. He said he is waiting on the Obama administration to answer some questions before deciding whether to establish a state insurance exchange.
One, he said, is whether states will be able to create wellness-based incentives. Another is whether family members using different plans will be covered by the same provider. A third asks how the state can avoid being double-billed by seniors transitioning to Medicare. "You literally have us saying we want to come sit and talk about this to ask some of our questions and get some answers," Haslam lamented.
How lame. Tennessee, like most states, has enormous experience in health insurance. State government has operated Tennessee's Medicaid/TennCare program for poverty-level citizens for decades, largely through BlueCross BlueShield, the state's largest insurer. The state and its insurance contractors, including those that have regularly bid for the state's employee insurance program, have plowed through thousands of process questions over many years. For Haslam to claim, at this late date, that he's "waiting on Washington" to figure out how to implement a state insurance exchange for ACA-compatible insurance policies is an unbecoming charade.
More to the point, Haslam is fooling around with the health-care future of a huge number of Tennesseans who sorely need and deserve the benefits of the ACA. TennCare covers only those below the federal poverty level. With incomes above that, more than a fifth of working-age Tennesseans remain uninsured.
Many work for employers who can't or won't provide affordable insurance. Others, including self-employed workers, are excluded because insurance cost too much, or because of pre-existing conditions. Other workers defer switching jobs, or taking early retirement, because their insurance is tied to their jobs. Still others live in fear of medical calamities and bankruptcies because they are grossly under-insured. Indeed, more than 60 percent of the nation's individual bankruptcies are due to medical bills, and thousands die quietly every year because they can't afford life-sustaining cancer treatments.
The ACA would put an affordable, comprehensive floor under the uninsured and the under-insured by providing affordable insurance to more than 30 million Americans. At the same time, it would reduce the nation's share of spending on health care by replacing expensive emergency room care with cheaper preventive and routine care and by adding millions of new insurance payees.
Insurers that join state ACA exchanges must offer community-based flat-rate, comprehensive insurance, regardless of gender or pre-existing conditions to Tennesseans who have no insurance. The barrier of pre-existing conditions will be banned. Ample preventive care standards, including many measures specific to women, will be covered. And workers with incomes of up to 400 percent of the poverty level will receive wage-adjusted subsidies to make insurance affordable.
Two model national plans, including one now available only to federal employees, will be included in state exchanges, and will serve as competitive models. The federal government will establish the exchanges in states that refuse that responsibility.
With so many Tennesseans who would benefit, Gov. Haslam should want to play a positive role in establishing Tennessee's ACA health-insurance exchange. But if he's too timid, or too partisan, or too uncaring, or too short-sighted to take charge, he can let Washington do his job.