Tuesday, February 19, 2013

Take that Socialism!

Sarah Kliff at Wonkblog had a good summery about where we stand on the much vaunted health insurance exchanges being set up under Obamacare.  Basically the Feds will run 26 of the nations 51 exchanges and will partner with another seven other states to set up their exchanges jointly.  The remaining 17 states and DC will run their own.  As she points out, this is overwhelmingly due to Republican Governors refusing to set up their own exchanges.  Ironically this GOP attempt to limit the horror of Kenyan socialism is actually giving liberal policy wonks a bit of a victory:
Remember, House Democrats originally wanted one national health exchange, where everyone in all 50 states could purchase coverage. That idea was nixed in the Senate bill, which aimed to give states a larger role in setting up the Affordable Care Act.
In a way, all these states turning over their exchanges to the federal government brings Obamacare a little closer to the more liberal House bill, which had the federal government running one big marketplace. It allows the White House to have more control over setting up its signature legislative accomplishment. It also creates some economies of scale, as HHS can develop one template exchange that all 26 states it handles will use.
Kliff also points out that if the GOP Governors really wanted to damage Obamacare, and thus make it more unpopular, they could have decided to make their own exchanges and then done a horrible job implementing them.  Not a very noble tactic to be sure, but it strikes me as probably the most effective one available.  At the very least if people like Rick Perry decided to set up exchanges, they could have worked to make them as Spartan as possible.  By bravely trying to stand in the hospital door people like Scott Walker are in a way helping the President's agenda.

Don't like that comparison?  I'd argue that the comparison to George Wallace helps explain a lot about this kind of decision.  Take Wallace's  language from 50 years ago out of context and it sounds like something a Bobby Jindal could say at a press conference tomorrow, "I stand here today as governor of this sovereign state, and refuse to willingly submit to illegal usurpation of power by the central government."  And just take a look at the handy map from the Kaiser Family Foundation, every state of the Old Confederacy except Arkansas is refusing to set up a state based exchange.  As Rick Perlstein likes to point out, their's nothing new under the wingnut sun.

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