Health Care Thoughts: Health Exchange Delay
by Tom aka Rusty Rustbelt
Health Care Thoughts: Health Exchange Delay
The Obama administration has delayed the decision point on state health exchanges until December 14th.
Much of the discussion on this issue has centered on politics. My focus is on more practical issues.
The Obama administration has a track record of being unable to develop administrative regulations on time and for writing complicated and incoherent regulations. We still do not know for certain what “essential benefits” might be and how the administration will balance intense lobbying on this issue versus affordability.
From a management and financial viewpoint it may make perfect sense to have the feds install their “plug-and-play” model exchange and to let the feds do the heavy lifting, politics aside. Maybe the Democrat governors are wrong on this one?
I think you could make a great contribution on this subject if you would focus on practical issues and not politics.
It may or may not be true that the Obama administration is particularly inept, but by dragging in politics you make it hard to focus on more practical issues.
A failure of bureaucratic competence is a political issue?
If the federal government is going to reform the US health care system the federal government should meet its own deadlines.
i guess you can’t see it, being inside it. but as long as you say “the obama administration….” implying that they are unusually inept, you make it a political issue.
at which point all thought stops.
you could point out what is wrong with it without pointing political fingers.. while denying you are doing any such thing.. and have some chance of fixing it.
I was cool with this post until the comments section. The reason for the delay has little to do with President Obama and much more to do with the states who thought he would lose with emphasis on the red states.
The President controls and directs the executive branch.
The executive branch is charged with writing, publishing and enforcing administrative regulations pursuant to statutory requirements.
The failure to write and publish administrative regulations in a timely manner falls on the executive branch.
Please tell me if this is wrong somehow.
It is very difficult to adhere to administrative regulations not yet written. Ten (10) months is not much time to put together a state-wide health care exchange.
Could it be that the funds for insurance subsidies have not materialized while cost estimates have soared?
Funny, nothing appeared to impede California (first state) Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont and Washington and many more from establishing State “run” insurance exchanges?
“It’s the second time in a week that Sebelius let the governors slide. Last Friday, HHS said the states could have nearly a month extra to submit plans of what their exchanges would look like, if they decided to set up their own. She gave them until Feb. 15 to detail plans if they wanted to partner with the federal government to build an exchange.”
The operation of the exchanges are meant to be by the state. I can understand that those who opposed the PPACA and President Obama in re-election may not have the brain-power to be intuitive enough to manage such an event in the same manner as putting together an attack on the PPACA and going to SCOTUS. HHS secretary has asked (mind you asked them for an opinion) of what states believe a state exchange should lokk like initially. Sounds like a lot of latitude in being given to states rather than a mandate being handed down which is on the horizon if the Fed takes it over.
Republicans are still fighting a war against the Black Man in The Big White House.
what is wrong with it is
YOU said you weren’t going to get into politics.
i agree that avoiding politics leaves you free to make good suggestions.
But you can’t “avoid politics” and blame Obama at the same time.
what is funny here is that you can stand there and piously claim to “avoid politics” in one breath and then blame Obama, and then innocently ask “how can the President not be to blame?”
well, I don’t know. but if you are going to make it a political issue, at least know what you are doing.
Let’s see if the exchanges are operational by 10/1/13 and if the exchanges work as intended.
So no one is responsible if the executive branch doesn’t do its job?
Just learned something disturbing (I will check it further but it seems to be true).
A family purchases insurance through an exchange using the federal tax credit based on an estimate of earning 350% (< 400%) of the Federal Poverty level. Due to some overtime at the end of the year the family earns 405% of the FPL. How much of the credit must be repaid? Apparently 100%. Ouch. This needs some followup.
This is amazing. you said you weren’t going to get into politics. then you got into politics. i pointed that out. you then seem to think i am saying that politics has nothing to do with the problem.
i am not saying that. i am saying you ought to at least recognize when you are talking politics and stop pretending to yourself that you aren’t.
Federal poverty level 2012 – 4 person family: $23,050.
350% of FPL 2012: 80,675
405% of FPL 2012: 93,352
Time and a half: 58.19
That’s a hell of a lot of overtime.
yes it is. but if Rusty is right (doubtful) it would suggest a need to more carefully write the law so that gaming the subsidy would not be so attractive.
generally the government is careful to graduate these things so that no increase in income results in a net loss due to higher tax rate.
According to The Hill, the date was delayed to help Republican governors who were absolutely convinced Obama would lose the election and they wouldn’t have to implement their exchanges. Sounds a lot more like an issue with the Governors than with the Obama administration. Maybe leaving politics out of it WOULD have been a better idea?
Rules published yesterday. No time to read them until next week.
Also published were rules on insurance, focused heavily I think on existing condition coverage.
The buzz I get from people smarter and more connected than me are that both the states and the feds will have to contract out much of the work, especially IT, and that the time frame is going to be really tough.
Also, buzz is consultants are geared up for a record year in 2013.
Hugh, I think you are confusing the decision date with the publication of implementing regulations.
Actually, the late publication causes problems for the states that already said yes.
Coberly, happy holidays.
FYI, I am trying to edit a book on the implementation of PPACA section 6102, implement date 3/23/2012, and guess what?
The administration has not written the regulations yet.
Lawyers specializing in this area tell me that the Office of Inspector General has a wink-wink rule on delaying the enforcement of 6102 until we know the rules.
But that is politics I guess.
first, i genuinely hope you and yours have not only happy holidays, but a good life.
second, try not to take my grumpy way of putting things personally.
third, i still think you can make a good contribution to this subject if you can avoid sounding partisan. which was my point in the first place.
i know that is hard. i have trouble avoiding sounding hostile, and that is much the same as sounding partisan.
for what it’s worth i don’t like Obama or Obamacare any better than you do. but my liberal friends don’t understand what i mean when i say that.