Melissa Harris-Perry on her MSNBC show Sunday discussed the future of state health insurance exchanges, and some panelists argued that ceding control of the exchanges to the federal government — which many states with governors or legislatures which oppose the Affordable Care Act are likely to do — could result in a better deal for people in the market.
As part of the Affordable Care Act, each state is required to have a health insurance exchange, or a website where those seeking coverage can easily compare plans. States can create and run their own exchanges, do so in partnership with the federal government, or decline to participate at all, which leaves the creation and running of the exchange entirely in the hands of the federal government.
To date, “Seventeen states and the District of Columbia have decided to establish their own state-based exchanges. Five states are opting to partner with the federal government, and 18 states have indicated they are either unable or unwilling to establish either of those options,” Harris-Perry said.
“If we know nothing else about the Republican Party, we know the gospel of the GOP is that states should have control over their own decisions and that big federal government should butt out. So why is it that the people who are the staunchest defenders of the idea that states know better than anyone else what’s best for the states are the very same people who are content to let the federal government come in and run their health care markets?” she asked.
New Jersey Gov. Chris Christie has said, most recently on the Daily Show with Jon Stewart, that the uncertainty of the cost of the exchanges led him to veto the creation of one in his state.
But Harris-Perry argued that California, the largest state in the nation, has opted to run its own exchange and managed not to spend money from its general fund to do so, thus far.
Jay Engoff, a former official with the federal Health and Human Services Department, said, “Exchanges, if they’re implemented correctly can, for the first time, give individuals, who’ve had no bargaining power against insurance companies, the same bargaining power that they would have if they worked for a large business,” and offer “apples to apples” comparisons that will drive down insurance prices.
He said that insurance companies and hospitals would actually prefer states themselves to run the exchanges because they “will not standardize benefits packages, will not really enable people to make apples to apples comparisons,” whereas federally-created exchanges will do so.
“So the insurance companies, ironically,” he went on, “they want the governors and the states to elect to do the state exchange, whereas the other part of the Republican’s constituency, the Tea Party people, they just want the state to do nothing, and to allow the federal government to do it.”
Panelist and Rep. Donna Edwards (D-Md.) said that some in Congress originally wanted more “universality” in the system and that the option for state control was a compromise.
But now, she said, a large state like Texas, where Gov. Rick Perry has publicly dismissed the exchanges, “becomes a major major marketplace for experimentation.”
Harris-Perry then pointed out that the list of states with the most uninsured had a significant amount of overlap with states whose governors have voiced opposition to creating state exchanges.
However, panelist and NYU professor of constitutional law Kenji Yoshino said that Tea Partiers would disagree with how Harris-Perry construed the Supreme Court decision on the Affordable Care Act, as the court placed limits on Medicaid expansion and on the “commerce” clause of the constitution, a boon to states’ rights advocates.
Watch the video, via MSNBC, below.