http://www.washingtonpost.com/blogs/plum-line/post/bobby-jindals-big-blow-for-states-rights/2012/06/29/gJQAm7F9BW_blog.html

How sweet would that be?

a) If push comes to shove, Federal Law trumps State Law. That principle was established in 1865, more or less. and,

b) It's not like the Feds actually have to ASK. The beauty of this kind of Federal program is that it doesn't require a presence in the States. It would be a WEBSITE and some letters arriving in your mailbox. There wouldn't be like the Federal civil rights laws, with dramatic black and white news footage of Federal Army troops escorting a health insurance plan down the sidewalk to the Alabama Legislature, being spat on all the way, only to find Governor Bentley blocking the door.


And while we're on the subject, can the Democratic party PLEASE stop appeasing this silly 'states rights' issue by handing States federal money to administer federal programs? This is not only irresponsible, but politically stupid. If the Federal government pays for a program, the Federal government should administer it! No more of this nonsense about handing Federal dollars to teabag Governors, letting THEM hand it out and take credit for it, and then turning around and shouting nasty names at Washington. Every one of those teachers, cops and fire fighters who was kept afloat by FEDERAL money last year should have gotten a check from the FEDERAL GOVERNMENT, DIRECTLY.

... but there would likely need to be the means for a person to walk into the state office of the department that administers Medicaid to fill out paper forms to join the Federal HBE.

In Kansas, where Sam Brownback is threatening not to establish an exchange, that would be the Kansas Department of Health and Environment, I believe. There would have to be the means to file paper forms to join the Federal HBE.

It seems very unlikely, but Brownback could post State Troopers at KDHE offices to turn people away who wanted to apply for the Federal HBE. I suspect that would lead to Federalized National Guard Troops and First Infantry Division troops showing up at KDHE.

The name Brownback would be remembered alongside of Wallace, so it would not be all bad.

The states in question are, almost invariably, those on "welfare" ... states whose federal payments are far lower than the federal assistance they receive. The "blue" states subsidize the "red" states to the tune of hundreds of billions of taxpayer dollars. Further exacerbating this, these states have more regressive state and local tax structures than the average in the country, effectively shifting the tax burden to those with the least income. It's not surprising (to me, at least) that they're also at the low end in education and literacy. The poor shlubs are getting fucked over and they keep voting for the fuckers.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=881967

Let's say 15 or 20 Republican Governors make a show of not setting up an exchange. The Federal Government can simply set up one exchange to service all 20 of those States, and due to economy of scale (it would, no doubt, include Texas and Florida, with large populations) it would probably offer the most plans at the lowest prices.

One very simple way for the Feds to do this would be to simply open up the Federal Employees health plan exchange to EVERYBODY. Just expand an exchange that already exists, which the people who use it are very happy with.

http://en.wikipedia.org/wiki/Federal_Employees_Health_Benefits_Program

Then, when people see how well it works, other states will ASK to use that exchange, one by one, until there is just a single national exchange!

That's phase I. Phase II is then to simply put a PUBLIC OPTION on that exchange. It wouldn't necessarily be MEDICARE, because this would allow Republicans to scare everybody ala "keep your government hands off my Medicare!" So, an alternative might be to combine ALL of the OTHER government plans (veterans, SCHIP, Medicaid etc.) into a single pool, and sell it on the market. The government run HC plan would probably be like Medicare in that it would have a 1 or 2% operating cost, just like medicare.

In the end, the private HMOs couldn't compete with a non-profit government run plan, and the plans that would remain would be the Government one and maybe some private, non-profit co-ops.

If it were me, I wouldn't move to drive out the co-ops. It might be good to keep just one or two of them around to keep pressure on the government plan to stay as efficient as possible.

I agree with you to keep some of the co-ops. A couple of privately run exchanges would be the perfect answer to those who believe the private sector can do everything better. Fine, let 'em, but if they fuck over people, there would be Medicare Part E.

. . .but it's another step closer to it, IMO.

And if the GOP governors are dumb-fuck enough to "unwittingly advance the cause for single-payer" by their resistance to Obama, so much the better.

Pace yourselves and keep on pushing. We will get there eventually.

Last edited Sat Jun 30, 2012, 09:47 AM - Edit history (1)

The State exchanges should operate virtually exactly like the federal exchange. The Feds will be state based even if they are the ones implementing it in your state.

There are some things in the law that essentially lead to single payer though.

Remember, it doesn't do any good to get so hung up on the words "single payer" that you miss the point of progress. A State, by itself, could have single payer. There could be 50 single payer systems in the country. In scale, this would not be that different from Canada.

Here are some provisions that move us (or can move us, if states take the lead in some cases) in the right direction:
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Health Care Choice Compacts _ Permits states to form health care choice compacts and allows insurers to sell policies in any state participating in the compact.Implementation: January 1, 2016

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Basic Health Plan _ Permits states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.Implementation: January 1, 2014Implementation update: On September 14, 2011, CMS issued a request for information regarding state flexibility to establish Basic Health Plan.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Multi-State Health Plans _ Requires the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.Implementation: January 1, 2014

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

And mostly, if these are done right:

CO-OP Health Insurance Plans _ Creates the Consumer Operated and Oriented Plan (CO-OP) to foster the creation of non-profit, member-run health insurance companies.Implementation: CO-OPs established by July 1, 2013Implementation update: On March 14, 2011, the Department of Health and Human Services (HHS) issued a report on the Consumer Operated and Oriented Plan Program. The report included recommendations by the CO-OP Advisory Board on governance, finance, infrastructure, and compliance. On July 18, 2011, HHS published a proposed rule that would implement the CO-OP program. On December 13, 2011, HHS issued a final rule. On February 21, 2012, HHS announced that "seven non-profits offering coverage in eight states have been awarded $638,677,300."

http://serpline.blogspot.com/2012/07/increasing-millions-in-red-states.html