A key aspect of Obamacare is its mandate for health insurance. To make finding coverage easier, beginning in 2014, consumers and businesses will be able to shop for and compare insurance plans on websites known as “exchanges.
States can set up their own exchange, putting them in control of key decisions such as which insurance plans are offered and what they must cover. States can also opt out and let the federal government make all the decisions. A third option exists for a state-federal hybrid. Today was the deadline for states to indicate whether they would run a state-based exchange, with blueprints due by mid-December for their implementation. States wishing to partner with the federal government on a hybrid have until February 15 to submit the blueprint.
Today, all eyes were on the Kasich administration to see what they would choose.
Tea party types want absolutely nothing to do with Obamacare, strenuously opposing a state-run exchange as an endorsement of the law. The Ohio Liberty Coalition yesterday reminded Kasich that in 2010, he made a campaign promise to “block Obamacare.” The 1851 Center has promised to sue the state if it opts for a state-run exchange.
Meanwhile, more moderate voices in the Republican coalition — namely the business community, in particular the state’s insurance industry — have argued for a state-run exchange, which would ensure that Ohio could establish rules that will benefit Ohio’s homegrown insurance companies and, in turn, the 400,000 Ohioans they employ.
Today, Kasich tried to have it both ways. His website carries the following banner:
He tweeted that he had “said no” to a state-run exchange:
He even put a video on his campaign website featuring Mary Taylor explaining why they left the exchange “to the federal government.”
But that’s not what happened. If you read the announcement closely, and know what to look for, what Kasich actually opted for is the hybrid state-federal model in which the federal government does the heavy lifting but works in close partnership with the state who helps to establish the rules of the road. A big clue comes at the end of the statement when they say “Ohio will inform the federal government of its plan for preserving these rights early next year.”
It gets clearer if you were lucky enough to get the following clarification from spokesperson Rob Nichols, which arrived in inboxes of some in Ohio’s business community today:
This morning, Gov. Kasich informed the U.S. Department of Health and Human Services that Ohio will not run an Obamacare health insurance exchange but will leave that to the federal government. Also, he informed HHS that Ohio will retain regulatory control over health insurance plans offered through a federally-operated exchange as well as retain the authority to determine who is eligible for Medicaid benefits. The Administration will submit additional details to the federal government prior to HHS’s February 14 deadline.
See that last line? The February deadline (it’s actually the 15th) refers to the date HHS has given states to provide a blueprint for a hybrid state-federal exchange partnership. States opting for a purely federally-run exchange don’t have to submit a blueprint. Ohio is going in on Obamacare implementation in partnership with the federal government, despite the impression they are trying to give to their right wing.
It’s hardly the hands-off approach desired by the tea party.
Kasich and Taylor don’t want to upset their tea party supporters and let them know they are going to be willing and active partners in the creation of a hybrid state-federal exchange, so they left those words out of all their public releases. At the same time, they needed the business community to know they hadn’t actually caved in to the crazies in their party and sent clarifications by email and made reassuring phone calls to ensure that, despite their public rhetoric about “saying no” they’d actually decided to join hands with the Obama administration to jointly launch an insurance exchange in Ohio.