By Shunning the Exchanges, Republican Governors Helped Taxpayers and Helped Make ObamaCare Work Better

A new report, by former Missouri Insurance Commissioner Jay Angoff, shows that states in which governors and/or legislators resisted ObamaCare, and whose Attorneys-General challenged its constitutionality, had the lowest cost-per-enrollee:


States which established their own ObamaCare exchanges cost much more to enroll people. The worst, Hawaii, cost $23,899 per enrollee. The “best” of the state-based exchanges is California‚Äôs, which cost $758 per enrollee. For all states with their own exchanges, the average cost was $1,503 per enrollee.

If heavily populated Republican states, like Texas and Florida, had established their own exchanges that cost the same as California’s, the bill to federal taxpayers would have been $15 million higher than it was. If they had set up exchanges that cost the same as the average state-based exchange, the tab would have been $30 million higher.

Comments (9)

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  1. Devon Herrick says:

    I’m reminded how the biggest complaint against private health insurance that advocates often voice is that the overhead is too high. Purportedly, the cost of marketing, outreach, underwriting and follow up is too big a portion of the cost.

    The abysmal way the state health insurance exchanges have been implemented adds ammunition to this argument. Next year (and the year after) exchange plan premiums will rise due to adverse selection. My fear is that the poorly implemented exchange system will push the U.S. health care system towards a Single-Payer Monopsony rather than the reverse that proponents of the exchange system had envisioned.

    • Perry says:

      Single-payer is I think what most Dems are aiming for, I just don’t see it going over in this country. Maybe people will become so frustrated with the current system they will throw up their hands and give up.

  2. RSW says:

    I would be interested in seeing more on things like average cost of coverage, healthcare costs relative to the rest of the country, etc in these states.

    • John R. Graham says:

      That information is widely available, but I don’t think it bears on this question. The cost of erecting a new government bureaucracy will be driven by many things, but the actual value of the services delivered to the beneficiaries will not be one of them.

      For example: Unstated objectives of the project (in this case, to register low-income people to vote); taking care of friends in business (especially IT contractors); and competing demands for taxpayer money by other interest groups.

  3. Jenny says:

    I wonder what the average was for those with state-based exchanges.

    • John R. Graham says:

      Chris Conover and colleagues at posted an estimate a few days ago.

  4. Erik says:

    So by passing on the expense of creating their own state exchanges to the federal government these GOP politicians saved their states money but cost everyone else more in taxpayer dollars?

    This is standard operation for the southern states who receive more in taxes than they contribute.

    Nothing new or exceptional here

    • John R. Graham says:

      Thank you for your comment but I think you have misunderstood the post. The states which did not set up their own exchanges saved taxpayers money.

      Plus, the states that set up their own exchanges cost taxpayers more money that reflected in the information above, because they not only spend federal money but also state money.