Was It a Mistake to Let the States Run Their Own Exchanges?
…[M]onths after the federal exchange finally limped into production, about half the state-run exchanges “remain dysfunctional, disabled, or severely underperforming.” This, even though we have spent almost twice as much on building exchanges for 14 states and the District of Columbia as we did on the federal exchange, which covers the residents of the other states.
If the red states had built their own exchanges, many of them would likely also suffer the same problems — or worse ones, given that red-state governors lacked the enthusiasm of their blue-state counterparts. Naturally, this raises some questions. What if the administration’s supporters who complained about red-state intransigence had it backward? What if the mistake was allowing states to do a job that we should have left to the federal government?
…So should Congress have simply had the federal government build the exchanges and be done with it?
Megan McArdle answers:
Actually, no. The architecture of the law allowed for some failures. But it also enshrined two important principles for failing well: experimentation and diversification.
“What if the mistake was allowing states to do a job that we should have left to the federal government?”
I don’t think that would have been any better either.
The problem is the federal government wants everything in health care to be cookie cutter, across states and populations that are extrememly diverse.
For an administration that got a lot of support from Hispanics, they are still having problems with the Spanish-language health care sign up.
Perhaps the federal government should not have only used google translate to provide the exchange to Spanish speakers only.
This article shows a little bit partisan inclination.
“For an administration that got a lot of support from Hispanics, they are still having problems with the Spanish-language health care sign up.”
Nothing could be easier than English-Spanish translation..
Actually it can get pretty tricky. It isn’t as simple as you make it sound like. Especially considering that in Spanish there are several ways to say the same thing. Different Latin-American countries have different words to refer to the same thing. If they are not careful, they can end up translating it correctly for a Mexican but it might be insulting to a Peruvian.
“When the federal exchange was down, New York and California were still able to sign people up.”
When approaching the exchanges, diversification was the best way to go about it. If they had not had back up plans when federal or state exchanges went down, it would have been even more havoc.
“And because the legislation had just assumed that the states would mostly build their own exchanges, using the federal government only as a fallback,”
Once they realize the red states were not having any of that, the Federal exchanges got so backed up and fell apart.
Maybe they should have planned for all negative outcomes. Rushing the exchanges when they aren’t built to last was the wrong way to go about it.
“If the red states had built their own exchanges, many of them would likely also suffer the same problems — or worse ones, given that red-state governors lacked the enthusiasm of their blue-state counterparts.”
This conclusion is not tenable enough to avoid being punched a hole.
Maybe it won’t occur for certain, but it is a realistic conclusion. When you do something that you don’t want to do, you normally would do it worse than what you would normally. So the reluctance of the red states would translate into the exchanges. Because they were forced to do it they probably would have done the bare minimum to meet the law.
But maybe it is the complete opposite. Because the red states didn’t have the political interest the blue states had, they would have probably outsourced it or paid a private company to do it for them. Maybe they were up to the challenge and would have done a better job just to proof that the red states are capable of delivering what they promise.
You have a good point. Maybe one of the reasons why the state exchanges failed was because they didn’t have competitors. The blue states knew that the results of the exchange would be compared to other democrat institutions, thus they didn’t thought that it could cause a political consequence.
Have we have forgotten that the States have a certain degree of independence per the Constitution? In fact, that is why the Supreme Court ruled that the Medicare expansion could be determined by each state individually. Let every state decide how to handle the mandates, if they fail; good, if they succeed; even better.
Insurance exchanges by themselves are easy. A couple of grad students at Stanford created a pure buyer’s exchange over about 3 days. E-health insurance has been running for several years.
What gummed up the ACA exchanges was the attempt to determine subsidies on-line. This required interface with antiquated IRS and Social Security data bases.
I know next to nothing about programming, yet this was obvious to me 15 months ago. Funny that no one told the Prez about this problem.
As for the federal vs state problem……..
The first 4-5 years of FDR’s presidency was dominated by efforts to get the states on board with the NRA, WPA, unemployment insurance and farm relief. Harry Hopkins in Washington had to become a virtual dictator at times, and given that literal starvation was looming in some places, history has judged Hopkins rather well.
Of course the ACA is lot less clear cut than feeding people or giving last-ditch employment. Some of the resistors to the ACA may be be given credit in later years. Rick Perry and Ted Cruz will be treated better than people like Sen Gene Talmadge of Georgia, who was apoplectic that blacks would be paid $5 a day by the WPA and warned his colleagues that “these shirts don’t fold themselves.”