Nancy Pelosi once famously advised some questioners to not bother being too curious about Obamacare, then under discussion. "We have to pass the bill to find out what's in it," she told them.
As usual, the then-Speaker's advice was self-serving at best. They passed it alright, but the more we "see what's in it," the more Obama's flagship policy victory seems headed toward disaster.
Gov. Brewer's decision to decline a state run health insurance exchange wasn't an act of partisan spite. It was the only reasonable decision she could have made under the circumstances. She emphasized the cost and the uncertainty of the incredibly complex rules still being written that we would be expected to enforce.
But we know enough about the insurance exchanges to know this would have been a horrible deal for Arizona. The exchanges are web-based marketplaces where federally approved insurance plans are matched up with buyers and where all applicable rules and subsidies are applied. Arizona isn't required to operate an exchange. The feds may establish one now that we have passed.
Advocates for a state-based exchange claim that we could maintain local control over insurance policy. But that's simply a myth. The law nobody read plainly states that "an Exchange may not establish rules that conflict with nor prevent the application of regulations" established by the Secretary of HHS. That means the state would have been tasked with funneling patients and their premiums to insurance companies under federal rules while we picked up the tab. Why are they surprised that over 20 states so far have turned down such a deal?
Big Health and the insurance companies may fume over seeing all their agreements with the Obama administration unravel, but there were even more disincentives for the state to sign on. Under a state-operated exchange, state businesses would have been subject to fines that a federally operated exchange won't be allowed to assess. We would have been required to report to the IRS data on Arizonans who changed or terminated their insurance coverage and to share certain health information with the feds.
Gov. Brewer also had to consider that such an unwieldy, overcomplicated law will likely be a nightmare to administer. For example, take the simple matter of determining eligibility for the various subsidies. The exchange subsidies vary by family size and income. They may be different for different members of a single family. Yes there is no federal agency, let alone state, that can verify any family's income.
The closest is the IRS, which (usually) knows by April 15 a family's income for the previous year. Of course, that still leaves out the millions of Americans who don't file with the IRS and creates a problem for those whose incomes vary from year-to-year. It’s a problem, but it doesn’t need to be our problem.
Actually, as Greg Scandlen points out in Townhall.com, almost everything in Obamacare was poorly thought out. The new insurance mandates are going pretty well, because the insurance companies decreed them. Even so, thousands of waivers from these requirements were issued to folks unhappy with the new higher premiums, primarily to constituents of high-ranking Democrats.
But remember the CLASS act, the much-anticipated provision to provide long-term care insurance? It's gone, deep-sixed when the administration realized it was simply unaffordable. Or remember the 1099 provision, requiring businesses to issue a 1099 form to any vendor from whom they purchased $600 worth of goods. It left too when folks who really run businesses explained to those who never have that it was preposterous.
Highly touted federal risk pools have had few takers due to cost and complexity. Meanwhile, retiree health subsidies were quickly snapped up by unions and businesses who already pay for seniors and the money in that fund soon ran out.
Even the Medicaid expansions in the states, once the Supreme Court ruled they were voluntary, have lost their appeal. It looks like fewer than half of the states will sign on.
The last thing Arizona needed was to become a minion of the federal government in administering this unworkable and unpopular program. Better options based on consumer choice are out there once we dodge this bullet. Way to go, Guv.
Dale Whiting posted at 8:04 am on Sun, Dec 2, 2012.
Tom,
There was a time when Arizona lead the field in healthcare reform. Remember AHCCCS? Back then several states took up the challenge to come out with their own versions of the Federally mandated program now known as Medicare before the Federal program swept in. Medicare is the universal healthcare for the elderly. Now that we have universal healthcare for most everyone, based upon Romneycare, it's not hard to understand why you feel as you do. And as a part of Obamacare, much if not all of the fraud packaged up in Medicare claims will be routed out. Doctors will have a much harder time making bucks illegally.
chatmandu002 posted at 8:44 am on Sun, Dec 2, 2012.
Tom,
It's all to late for rationalization or understanding. The Takers have decided they want their Social Security, Medicare, Medicaid, welfare, food stamps and free birth control. Damned be the person or political party that may dare to take any of it away. The Takers haven't run out of other people's money yet.
Mike McClellan posted at 9:57 am on Sun, Dec 2, 2012.
Two things:
Note the irony of Patterson's last paragraph: "The last thing Arizona needed was to become a minion of the federal government in administering this unworkable and unpopular program. Better options based on consumer choice are out there once we dodge this bullet. Way to go, Guv."
Apparently, Patterson doesn't understand that by choosing not to administer its own health care exchange, Arizona's health insurance program will be under the direct control of the federal government. Thus, Tom, making us "minions of the federal government."
As to the plan itself, the consulting firm that the Guv hired to analyze which choice to make, Mercer, concluded the following: "a state- run exchange appears to be the lowest-risk, highest control, lowest cost option for Arizona."
We taxpayers paid $915,000 to Mercer so that the Guv could ignore their report.
Leon Ceniceros posted at 9:58 am on Sun, Dec 2, 2012.
HMMMMMMMMMMMMMM.....THE DEMOCRATS, LIBERALS, SOCIALISTS, "OCCUPY WALL STREET" ANARCHISTS, FEMI-GNATZIES, THE MINORITIES, THE UNIONS AND ALL THE COMMIE WANNA-BIE'S....LOVE OBAMA-CARE............
SO WHY ARE THEY SO AFRAID OF THE VERY SAME PRESIDENT OBAMA'S ADMINISTRATION RUNNING THE ........ARIZONA OBAMA-CARE......THE VERY ONE THAT THEY DESIGNED.
mnjcpa posted at 10:16 am on Sun, Dec 2, 2012.
Brewer is still getting us out from under the financial damage Napolitano left us in. We couldn't afford OC when it passed and we certainly can't afford it now. Great job standing your ground. I'm proud of the Republican governor's that are standing against OC.
Great article Tom.
Centrist posted at 12:05 pm on Sun, Dec 2, 2012.
It never fails to amaze me how Patterson and each of his "idealogue minions" refuse to accept the truth and will even go so far as to contradict themself in order to cling on to their fabrications about our society. Fabrications they have been fed by a conservative hate machine.
According to Patterson, Leon and mnj, the state of Arizona is supposed to operate "as free as possible" from the federal government's control. True mnj? I got that part of your phiosophy correct, didn't I? So, how exactly does Brwewer's punt to the Feds on the creation of a healthcare exchange do that? Answer: It doesn't. It is, in fact, an act 180 degrees from the dogma they spew. My goodness, how these folks, including and especially Brewer, talk out of both sides of their mouths.
But, I say, "Keep it up." As long as you so called conservatives continue to be fools following a foolish set of policies rooted in fear and selfishness, we even minded and compasoniate Americans will keep electing liberals. We will each continue to work hard to improve our status in life while helping those who are less fortunate and do so in a way that provides the opportunity of progress to all Americans. And that, my friends is how a god-fearing democracy should be run...liberal policies are not only more even handed, they are vastly superior to the so-called Republican mind set (which really is no longer based on conservative ideas and has become nothing more than a philosophy of selfishness and greed). Period. Lest you forget, Jesus was a liberal.
Good luck Patterson, Leon and mnj. You three are clearly nothing more than the drones Rupert Murdoch is trying to build. Why don't you try turning in your hate card for a card of cooperation. What a joke...
(And mnj, don't even try responding to me, your explanations are never more than, "But I have been trained in accounting principles and I meet with business leaders who hate Obama so I must be right...")
mnjcpa posted at 4:19 pm on Sun, Dec 2, 2012.
centrist - your wife must have let you out again.
What part of we can't afford OC is hard to understand? Does being even minded mean that we spend money that we don't have? Apparently so - that's the good liberal way.
Your comments are arrogant and condescending as if you have some moral superiority over others and wouldn't even consider an opposing argument. Myopic if use ask me but then again you're not interested in my comments.
Keep it up? Until liberals run America in to economic collapse - you bet I will.
downtownresident posted at 6:49 pm on Sun, Dec 2, 2012.
Tom,
The fact is that if Arizona had taken on this task, with the present administration and legislature, It would have been a major disaster for all Arizonan taxpayers. Oh, except for the insurance companies, who feed the politicians their money and propaganda streams. Which party will profit more, regardless of who runs it? Not the Democrats.
No matter which way this goes, the politicians and lawyers and accountants will always find a way to profit from the ills of the voters.
mnjcpa, Brewer couldn't get us out from under a paper sack.
Masterrogue666 posted at 7:01 pm on Sun, Dec 2, 2012.
@ Centrist: I agree with mnjcpa's comment directed at your statement. ANYONE has the right to voice their opinion, but you think you have the right to tell others not to comment here? Then you tossed in the "haters" lingo! Clearly you are the drone. Both Tom Patterson and mnjcpa explained (without using "hate" words, mind you) why Obamacare would be MORE COSTLY. That's what concerns more rational persons. But then, I don't consider you rational, due to YOUR comments.
Rich posted at 7:15 pm on Sun, Dec 2, 2012.
Like the new deal, Obamacare is a good idea, carefully crafted in a robust economy, a great idea. Badly crafted in a recession, idiocy. The economy can't recover when the uncertainty of it's effects, unintended consequences are known, can be predicted and dealt with. Investing without that would be irresponsible to say the least. If to implement it, you pull investment capital from the economy into the black hole of government debt, your grandchildren will be hoping for recovery long after you're gone. The voters bought the hype, not the facts. They bought the sizzle, not the substance. Perhaps in two years that may change, but for right now all it can do is get worse and you can count on the fact that it will. With Obamacare the government decides who lives and who dies and our founders didn't build a system to handle that eventuality.
Dale Whiting posted at 4:13 am on Mon, Dec 3, 2012.
Mike,
Notice how Tom's supporters avoid our points? We've hit the nail on it's head. They either don't know the head from the point or don't care to know.
CSalafia posted at 6:42 am on Mon, Dec 3, 2012.
"Brewer is still getting us out from under the financial damage Napolitano left us in. "
Wow.
The irony of that statement is astounding.
Isn't it time you quit blaming Napolitano?
Bluepoet posted at 8:17 am on Mon, Dec 3, 2012.
I also applaud Governor Brewer's decision--but not because it's good conservatism. I applaud it, because the Republicans in this state are truly scary, when it comes to administering any public trust. It's good that they at least acknowledge that lack of ability, in this instance.
Health care has reached the point of being non-affordable for most people, the way it is...what is needed is universal health care, if only to make it affordable. Because we could not come together to create a really good plan, we have this one, being implemented. This will be a stop-gap measure, to be sure, but it beats just leaving it all to the insurance companies and the hospital conglomerates.
The next big healthcare issue will be to somehow divorce insurance from employment altogether. I suspect it may take an amendment to do so, however...something I probably won't see, before I retire, or die...
VofReason posted at 1:09 pm on Mon, Dec 3, 2012.
Dale good refrence on AHCCCS. We are all aware that it pays for the majority of births in AZ now right? Think that was part of it's early intentions. Obamacare couldn't go that sideways too- could it? So now that Obamacare is passed, now they will route out the Fruad in Medicare. Hmmm, what was stopping them from doing that before? When they figure out that all this costs way more than there is money for, they will have to reduce the reimbursement on Dr Visits, procedures, etc etc. Anyone who understands Medicare knows that that is currently built in, but Congress folds yearly because they understand what will happen. Doctors will quit accepting Medicare patients and they won't have anywhere to go. That is the problem.
DonMey posted at 1:53 pm on Mon, Dec 3, 2012.
Mike - And apparently, you didn't read the article. Arizona could run its own exchange, but has to do it the way the federal government says. So why not cut out the middle man and make the federal government responsible for implementing their own laws? Or do you see this as a failing proposition, and want Arizona to take it on so we can blame Arizona Republicans instead of Washington Democrats when this spirals out of control?
Mike McClellan posted at 4:17 pm on Mon, Dec 3, 2012.
No, don, the feds give the states general guidelines, but the states have much more leeway than if the feds run it all.
And speaking of spiraling out of control, how about those death panels we call insurance companies, the ones who deny clients/patients medication, something that happens on a regular basis?
And how about what the gov's about ready to do with expanding Medicaid in the state -- deep six it -- which means more costs come to us one way or another.
Without the expansion, hospitals will still treat the indigent, and they'll pass those costs onto those of us who have insurance.
It's laughable for you to talk about health care costs spiraling out of control because of Obamacare -- newsflash: health care costs have been making huge leaps for years, long before Obama was even on the national scene.
DonMey posted at 5:02 pm on Mon, Dec 3, 2012.
Mike - Getting the federal government to mandate coverage instead of the market controlling it will force costs to spiral even more. For instance, how many insurance policies cover sex changes? When the fed gets involved, eventually they'll be forced to cover them; in fact, San Francisco's healthcare system for their uninsured already covers it...just like that judge who recently ruled we have to give a murderer a sex change operation who is currently serving life in prison.
wdgnas posted at 7:46 am on Tue, Dec 4, 2012.
republicans in power: healthcare a good idea.
democrats in power: healthcare a bad idea.
this is about deniability. plain and simple. see, i told you it would never work. if i put my head in the sand and hope for the worst
Leon Ceniceros posted at 9:49 am on Tue, Dec 4, 2012.
FUNNY HOW THE ...DEMOCRATS, THE LIBERALS, THE SOCIALISTS, THE ANARCHISTS, THE COMMIE WANNA-BE's.....IN ARIZONA ARE THE FIRST TO SCREAM....."SUPREMACY CLAUSE"....WHEN IT PERTAINS TO ...SB1070......
BUT WHEN OUR GOOD GOVERNOR CAN'T GET THE NEW OBAMA-CARE PROGRAM SENT TO HER FROM OBAMA'S SECRETARY OF HEALTH....SO THAT OUR GOVERNOR CAN SEE HOW OBAMA-CARE WILL AFFECT THE CITIZENS OF HER STATE........WHAT ELSE IS SHE TO DO.....AGREE TO RUN A STATE-WIDE HEALTH CARE SYSTEM UNDER THE RULES OF OBAMA-CARE............WHEN THERE ARE............"NO RULES".
IF OBAMA-CARE IS OUR NATIONAL HEALTH CARE SYSTEM THEN THE FEDERAL GOVERNMENT SHOULD BE RUNNING IT JUST LIKE THEY DO........."SOCIAL SECURITY" WHERE AN ARIZONA CITIZEN IS RECEIVING THE EXACT SAME BENEFITS AS A CALIFORNIA OR A US CITIZEN IN THE STATE OF MAINE.
THE SAME GOES FOR ...."OBAMA-CARE"....EVERY SINGLE AMERICAN CITIZEN SHOULD BE RECEIVING EXACTLY THE SAME LEVEL OF HEALTH CARE.
VofReason posted at 12:24 pm on Tue, Dec 4, 2012.
We are all still running with the working assumption that most things that the government does are ineffecient and cost much more than it should- right? Why would healthcare (expensive and rising as noted) be the exception?