States Take Practical Path on Exchanges

By: Joel S. Ario
– The Hill

When the Affordable Care Act was debated in Congress, the House of Representatives wanted one federal exchange and as much federal control of state insurance markets as possible. The Senate wanted state insurance exchanges and state flexibility to tailor market rules to local market conditions.

The Senate won, in part, because local insurance markets really do vary and are better managed at the state level, even when the federal government is setting the basic goals. In fact, state-federal partnerships are woven into the fabric of many healthcare laws, with the states zealously guarding their prerogatives, under both state and federal health insurance laws, to oversee insurers, protect consumers and promote competitive markets.

That pattern is being challenged as the ACA moves toward full implementation, and - ironically - it is the traditional defenders of states' rights who are voluntarily ceding state control. In more than half the states, Republican governors and legislators are under pressure from a small contingent of ideologues threatening primary challenges against any elected official who cooperates with ObamaCare.

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