Exchange politics for preparedness

We met recently with representatives of the Iowa Exchange Alliance. They included Chuck Larson, former Republican state chairman and legislator, as well as insurance and small business folks. All of them are wary of or oppose the federal Affordable Care Act's individual health insurance mandate, which the U.S. Supreme Court is reviewing.

Nonetheless, their coalition wants our state lawmakers to put political concerns aside and authorize Iowa to create a state-run health insurance exchange while we still can.

We agree. Iowa should not risk giving up the option of designing an exchange that best fits our state's needs. The stakes are enormous, given the escalating cost of health care and looming federal requirements.

Some background: Several of the 2010 Affordable Care Act's provisions already have kicked in. The pending mandate has been especially controversial. After after conflicting rulings in lower courts, the high court took on the issue and is expected to rule by late spring or early summer. Iowa is one of the states challenging the constitutionality. OK.

But even if the mandate is struck down and Congress eventually repeals or revises some or all of the legislation, it's in Iowa's interests to launch our insurance exchange this year.

The exchange is one of the federal legislation's central requirements. It's supposed to encourage competition among insurers and give consumers access to a variety of more affordable coverage options. States can devise their own exchange but legislatures must authorize a plan by Jan. 1. Otherwise, the federal government will step in.

Waiting to see what the Supreme Court decides or what Congress does after the November elections would severely curtail Iowa's ability to create by Jan. 1 the kind of detailed, tailored exchange plan Iowans deserve. Our state, with a strong national reputation in the insurance field and a highly respected insurance commissioner in Susan Voss, certainly has the expertise to do it well.

We also expect everyone - individuals, businesses and organizations - to be heard at the design table, but the exchange's complexity requires considerable time. Iowa's experts understand Iowans' needs better than federal officials.

Authorizing and planning the exchange doesn't come without costs, but Iowa already has a $7.7 million federal grant toward those expenses.

So why does the Legislature and governor's office continue to roll the dice with the big unknowns? Better to have a sound plan in place than to risk abdicating what we can control.

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