Governor Walker Should Establish a State Health Insurance Exchange

Governor Walker Should Establish a State Health Insurance Exchange

It is a mistake for Governor Walker to not establish a state health insurance exchange.
We are losing an important opportunity for Wisconsin providers and insurers to innovate our own system.
The Walker administration has argued that there are too many federal strings attached to a Wisconsin based system. I disagree.
The Obama administration has every incentive for the exchanges to be a success.  Moreover, Wisconsin has been very successful in persuading the federal government in the past to waive many Medicaid requirements that allowed Wisconsin to innovate and expand Medicaid. It was an outgoing Clinton administration  that approved the first Badgercare waiver sought by the Tommy Thompson administration. There have been tens of waivers approved. The feds do want to negotiate the details but our very able Secretary Smith is well equipped to negotiate–especially with many of the bureaucrats that worked for him at one time at CMS. It can be done on a bi-partisan basis.
Furthermore, surrendering  control to the feds will make it much more difficult for local providers and insurers to influence the details of the exchange. The hospital in Beaver Dam has little chance to be heard by a federal bureaucrat at CMS in Baltimore who is responsible for the whole country compared to someone in Madison who knows where Beaver Dam is, and the problems that might be faced by a small hospital serving a rural area. It is equally true for insurers and especially insurance brokers.
Insurance brokers have been particularly concerned about the impact of the exchanges. A broker in Mauston has a far better chance to get a fair deal from someone in Wisconsin like Dave Schwartzer, deputy insurance commissioner than form a distant federal bureaucrat. Brokers are understandably worried about the operation of the exchange but local control is always better.
Ultimately the Governor is understandably worried about the cost. There are two solutions: seek federal assistance which will be forthcoming if our efforts are sincere and pass  on some of the costs to users.
The alternative is a federal system which will greatly dilute the ability of the exchange to adapt to local conditions. I worry a great deal of the word coming back from Washington –“You could do it if you had a state sponsored exchange.”
What the decision has done unfortunately has set up a new blame game–whatever goes wrong the Governor can blame the feds and Democrats can blame the Governor.
It is time for an adult conversation about the Affordable Care Act. It is the law of the land and there will be exchanges. If employers allow large number of employees to devolve into the exchange they could easily become the largest pool of insureds in the state. Local hospitals, local doctors, local HMOs  and insurers need access and influence which has been greatly diminished by this decision.
Let’s hope the Governor will reconsider. It is everyone’s interest that the ACA be successful. Congress can change the detail with concurrence of the administration during the next four years–but Obamacare is not being repealed .
No matter what you think of Obamacare it is time to make the best of it

Leave a Reply

Your email address will not be published. Required fields are marked *