There are still at least two ways for conservatives to fight the implementation of ObamaCare. Thanks to the stupid ideological ruling of the Supreme Court, the states don’t have to accept federal money and expand Medicaid. They can just let their poor suffer. The states can also refuse to set up any health care exchange.
As Jonathan Cohn helpfully explains, you can think of the state health care exchanges as websites like Expedia or Travelocity. But, instead of renting a car or booking a hotel room or flight, you are shopping for a health insurance plan. You will also be eligible for a rebate if your income is low enough. In some cases, the entire cost of your health care plan might be covered, or, more likely, you might just be enrolled in Medicaid.
In refusing to set up a state health care exchange, the Republican governors don’t prevent their citizens from accessing ObamaCare. The law allows the federal government to set up the exchanges for them. In this respect, the citizens of Oklahoma, for example, won’t have a different experience from the citizens of New York or Massachusetts or California. However, James Capretta and Yuval Levin argue in today’s Wall Street Journal that the law won’t function if the states don’t create their own exchanges.
Congress didn’t allocate money for administering federal exchanges, and the law as written seems to prohibit federally run exchanges from providing subsidies to individuals. The administration insists that it can provide those subsidies anyway. But if the courts read the plain words of the statute, then federal exchanges couldn’t really function.
So, this issue will head to the courts where it will be decided whether or not there was some kind of legislative miscue that undermines the clear intent of the law.
It is important, however, to understand what Capretta and Levin are arguing. They are saying that the federal government can set up the exchanges but they have no money to administer them and no authority to send rebate checks to policy-holders who sign up on federally-created websites. So, for example, someone in Oklahoma could sign up for a policy but no one could process that transaction. And, if they did process it, no one in Oklahoma would be receiving the rebates. I think you can imagine how popular this will be with the people of Oklahoma.
The hope, obviously, is that by creating chaos in the implementation of ObamaCare, the Republicans can keep the program unpopular in their states.
How do you think that is going to work out?
