Plenty of 'what if' reform questions still linger

By The Des Moines Register

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It's easy to forget that Sen. Chuck Grassley was deeply involved in crafting the health reform law. As one of the “gang of six” senators in 2009, he spent months in bipartisan negotiations about how to cover millions of uninsured Americans.

Yet he is better remembered for criticizing health reform as well as for his untrue allegation that a government program would determine whether to “pull the plug on grandma.” More recently, he has taken numerous opportunities to denounced the so-called Obamacare on numerous occasions.

Now Grassley appears to be interested in how health reform is being implemented. He asked the Government Accountability Office to evaluate the progress in states setting up health insurance exchanges - a central provision in the health law. This fall, the online marketplaces will allow eligible individuals and small businesses to purchase private coverage that goes into effect Jan. 1, 2014. Some will receive taxpayer help to pay for it.

The GAO reviewed seven states, including Iowa, and recently issued a 38-page report in response to Grassley's request. Last week, the senator sent out a news release with a link to the report and the following comment: “This report highlights the complexity states face in setting up exchanges and how CMS's workload will increase dramatically in getting exchanges off the ground. The challenges that need to be overcome by Oct. 1, 2013, remain significant.”

The GAO wasn't so pessimistic: “Despite some challenges, the seven selected states in GAO's review reported they have taken actions to create exchanges, which they expect will be ready for enrollment by the deadline of Oct. 1, 2013.”

Of course, setting up new programs to insure millions of Americans isn't easy. But it is important to remember that Grassley was among those who pushed for the exchange-like model that offered private health insurance, instead of government coverage.

Lawmakers in Washington could have created a single-payer health insurance system to cover more people. Everyone would contribute to the cost and everyone would be insured. In fact, lawmakers considered expanding Medicare to insure more Americans. They worked to find agreement on a “public option” so Americans could purchase coverage from the government instead of private insurers in the new exchanges. They even considered a default public option in case reliance on private insurers didn't work.

Republicans opposed such ideas, calling them a government “takeover” of health care. So Democrats negotiated them away. Now millions of Americans will be turning to exchanges to buy private plans later this year. Rather than with a federal program like Medicare, states bear responsibilities in the health insurance exchanges. The complexities outlined by the GAO in setting up these plans are only the tip of the iceberg.

With no option for a government plan, private insurers hold a lot of power. What if they choose not to offer plans in the exchange? Will the government end up paying them more and more to do so? Will Grassley and other members of Congress be willing to revisit the reform law then - and maybe add a government-run insurance option then?

Let's hope so.