Partnering with feds better than state exchange

By Iowa City Press-Citizen


Friday was the deadline for states to tell Washington whether they would be setting up their own health insurance exchange to comply with the federal health care law, whether they would be looking to partner with the federal government on such an exchange or whether they would be asking the feds to set up and manage the exchange.

Gov. Terry Branstad waited (yet again) until the deadline to announce that Iowa will create a state-federal partnership exchange to help Iowans buy health insurance. He sent a letter to Health and Human Services Secretary Kathleen Sebelius to confirm the state’s decision.

The state-federal partnership seems a much better option than having Iowa leaders rush to set up its own system without having done all their homework.

Yes Iowa has had since March 2010 — when the Affordable Care Act was passed — to talk about how the state would move forward with setting up exchanges for residents and small business who otherwise might not be able to afford health care options on their own.

Unfortunately, no substantial progress was been made.

Instead, it seemed Branstad and many other Republican governors across the nation seem to have been banking on Mitt Romney winning the Nov. 6 presidential election. So instead of taking 2 1/2 years to plan they were left with only 10 days to decide the best course of action for their states before a first-round deadline last month.

Before that earlier deadline, Branstad said he wanted to avoid a federally run exchange, but lingering questions about the cost of a state exchange — especially how it would work with Medicaid and other federal programs and databases — may leave Iowa no choice but to join a one-size-fits-all exchange for it and other states.

We generally agree with the notion that Iowa would be better off with an insurance exchange designed by Iowans for Iowans. But so far, we haven’t seen any evidence that a state-run exchange would be any better than a federal run exchange.

Branstad seems to have come to a similar conclusion in now advocating for a hybrid, federal-state system. He said the state-federal model will allow Iowa to keep some control over its health care system and minimize costs.

The partnership option, however, will allow the federal government to pay for initial setup costs, including the computer technology and call centers required to run it. But the state will still have the ability to administer its own health care programs and regulate the insurance industry.

As the state and federal government work together to hammer out the details of this partnership, we continue to hope that they will use a much more open and transparent process than the governor has shown during the past few weeks.

And now that the governor has decided to call for a federal-state partnership on the health care exchanges, it’s time for him to turn his attention to another needed reform included within the Affordable Care Act: expanding the state’s standards for Medicaid eligibility.


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