Skip to main content

Better Off With a Federal Exchange


As the December 14th and February 14th dates draw near for states to say whether they will create Affordable Care Act health insurance exchanges and what they will look like, the world seems upside down.

Traditional “states’ rights” advocates such as South Carolina, Georgia, Alabama, Louisiana, and Texas all say they will let the federal government set up their exchange.  Historically “strong federal government” allies like Connecticut, Massachusetts, California, New York, and the District of Columbia are setting up their own exchanges.

In all, sixteen states so far have said they want the federal government to set up their exchange, while eighteen states and the District of Columbia have decided to run their own.  The rest are either undecided or looking to partner with the federal government.  No states are considering a multi-state exchange – so much for “selling insurance across state lines.”

The states that are deferring to the federal government cite a number of reasons.   Cost, uncertainty, and too-tight deadlines are the most common.

Politics is also a factor.  Of those sixteen states, only two – Missouri and New Hampshire – have Democratic governors.

But there’s another reason why people living in those states should be pleased that they are deferring to the federal government.  Historically, reluctant states don’t make the health and mental health of their citizens a governmental priority.

In this year’s list of the ten Best States for Your Health, five – Connecticut, Massachusetts, Minnesota, New York, and Vermont – are moving forward with state exchanges.  Three – New Jersey, Pennsylvania, and Utah, are still undecided.  Only two – New Hampshire and Maine – are opting for a federal exchange.

However, in this year’s list of the ten Worst States for Your Health, the results are subtly reversed.  Four – Texas, Alabama, Oklahoma, and Louisiana – are opting for the federal exchange.  Only three – New Mexico, Nevada, and Mississippi – are planning for state-run exchanges.

That may not seem like a big difference.  But when you look at all the states that have decided, those currently opting to run their own exchanges have an average ranking of just over 20th in protecting the overall health of their citizens.  Meanwhile, states deferring to the federal government have an average ranking of over 29th in protecting the overall health of their citizens – over nine places worse.

The difference is just as clear when it comes to spending to protect the mental health of their citizens. 
States opting to run their own exchanges also have an average ranking of just over 20th when it comes to funding mental health services.  States deferring to the federal government have an average ranking of almost 30th – nearly ten places worse.

Keep in mind that if all 50 states chose one or the other and divided equally, the best possible average ranking would be 13th and the worst possible 38th.

You can view all the states in two new tables here.

Where health and mental health are concerned, “states’ rights” often means state-sanctioned neglect.
There are individual exceptions, of course.  Maine and Alaska historically spend well on mental health, but are opting for a federal exchange.  Nevada and New Mexico do poorly on protecting the overall health of their citizens, but are embracing state-run exchanges.

The take-home lesson, however, is clear.  If your state doesn’t want to create its own exchange, then you are probably better off with the federal exchange.

And if your state is still undecided, be careful about what you wish for.  Floridians, for example, would probably be better off with a federal exchange.  The state ranks 33rd in overall health and 49th in mental health spending.

On the other hand, undecided Pennsylvania is 8th in overall health and 4th in mental health spending.  There’s a much better chance that a Pennsylvania exchange would be better for its citizens than any the federal government could offer.

The reason for worry in the reluctant states has to do with the flexibility all states will be granted in setting up exchanges. 

Last week, the federal government published a new set of proposed rules governing the “essential benefits package” – the key components of all health insurance plans to be offered through the exchanges beginning in 2014.  States running their own exchanges will be given a great deal of latitude in determining just how rich these benefits will be.

And as the clock ticks toward the Valentine’s Day deadline, it’s hard to imagine new love coming from the states that have rejected our health and mental health so many times before. 

If you would like to schedule Paul Gionfriddo to speak to your group or meeting, please email gionfriddopaul@gmail.com.

Comments

Post a Comment

Popular posts from this blog

For the Health of Our Community, Can We Plan More in Advance?

Mayor Florsheim has proposed a budget with a 2.7 mill increase for the coming fiscal year. This will mean an increase in taxes of approximately $500 per year for a home with a market value (not an assessed value) of $250,000, with larger increases for many homes in our city. While I appreciate the time and effort that went into his budget calculation, like many people I don’t believe that this is a sustainable increase on top of the increases of the past few years. What I appreciate even more is that the Mayor has invited members of the public to work together to offer their own perspective and suggestions to the City Council. In the past few weeks, I have offered several short-term suggestions, including a job freeze, a search for an alternative health insurance provider, and greater advocacy at the state level for fairer PILOT funding for Middletown. As an example, the Mayor’s budget proposes $77,800 for a Grantwriter versus zero from the Finance Department. Maybe we wait on that? ...

Veterans and Mental Illness

On a sultry June morning in our national’s capital last Friday, I visited the Vietnam Veterans Memorial .   Scores of people moved silently along the Wall, viewing the names of the men and women who died in that war.   Some stopped and took pictures.   One group of men about my age surrounded one name for a photo.   Two young women posed in front of another, perhaps a grandfather or great uncle they never got to meet. It is always an incredibly moving experience to visit the Wall.   It treats each of the people it memorializes with respect. There is no rank among those honored.   Officer or enlisted, rich or poor, each is given equal space and weight. It is a form of acknowledgement and respect for which many veterans still fight. Brave Vietnam veterans returned from Southeast Asia to educate our nation about the effects of war and violence. I didn’t know anything about Post Traumatic Stress Disorder when I entered the Connecticut Legislature in the...

Kamala Harris's Very Good Medicare Home Health Care Plan

My wife Pam and I bought private long term care insurance about twenty years ago. It’s a pretty good deal. For about $100 per month, we will someday – when we need it – be eligible for up to $200 a day toward either home health care or nursing home care. Add it up – it could save us hundreds of thousands of dollars as we age. I’ve been a big supporter of long-term care insurance since I was a Connecticut State Legislator in the 1980s. But to be honest, it’s never quite gotten the traction it should have. One of the reasons is that when people are young and healthy, they aren’t thinking about what their long-term care needs might be thirty or forty years down the road. But that’s when premiums would be most affordable. The bigger problem is that it’s really hard for insurers to predict the costs of long-term care that far in advance, too. The costs of care often far exceed those that are estimated way in advance. As a result, the policies that Pam and I have aren’t even offered anymore...