Local leaders appear at odds on how to proceed with implementing health insurance exchanges as part of President Obama's health care overhaul. A deadline looms next week for officials to send outlines of their proposals to the federal government.
Maryland and the District have proceeded aggressively in setting up their exchanges, but Virginia Gov. Bob McDonnell said this week that he has not gotten enough information from the federal government on the new law to make a decision on whether it would be a good investment for the state.
"I don't want to buy a pig in a poke for the taxpayers of Virginia," Mr. McDonnell said.
Mr. McDonnell also said Republican and Democratic governors have written to the federal government with questions, for example, on the services that must be covered by certain plans under the new law starting in 2014 or what it will mean for the expansion of Medicaid, the federal-state health care program used by people who do not have insurance and cannot afford to purchase it.
They essentially have received no guidance, he said.
States face a Nov. 16 deadline to submit their plans to the federal government, or they can choose to let the federal government step in and set up an exchange — an online marketplace where consumers without health insurance can shop for and purchase coverage. They also have the option of a federal-state partnership, though specifics on that option are less clear. Mr. McDonnell said it was his understanding that Virginia could see how the federal exchange is working and then opt in the future to change course if desired.
"I do not have — and other governors feel the same way — a lot of the information that would lead me to conclude today that a state-based exchange is the best way to go," Mr. McDonnell said, noting that the federal Department of Health and Human Services has extended the deadline for states to apply for certain grants until October 2014. "And because these questions have not been answered by the administration, or any governor — Republican or Democrat, for that matter — I can't make a responsible decision. So at this point, without further information, the only logical decision for us is to use the federal option."
State Senate Democratic Leader Richard L. Saslaw, D.C. Mayor Vincent C. Gray and Maryland Senate Majority Leader Thomas V. Mike Miller Jr. participated in a post-election forum Thursday at the Capital Hilton hosted by the Greater Washington Board of Trade. It touched on a wide range of issues of importance to the regional economy, including health care reform.
Mr. Saslaw, Fairfax Democrat, was one of several members of the Virginia General Assembly, including Republicans, who introduced legislation to set up a health benefits exchange. Mr. Saslaw's bill called for an exchange to be housed in the State Corporation Commission. Other bills would have set up the exchange based on recommendations of the Virginia Health Reform Initiative Advisory Council, part of a task force set up by Mr. McDonnell.
"Well, here's the choice — either you do it or the federal government's going to do it for you," Mr. Saslaw said. He added that the federal option "is not really the [preference] of at least most of the people I've talked to in the business community as well as the health services community. They want the state to have control over it."
Board of Trade President James C. Dinegar said it would be "nice" if the three jurisdictions would tackle the health care issue in a consistent way. Given the political landscape of Maryland and the District compared to Virginia, though, that could prove difficult.
"You're going to need choices — you're going to need not just the choices but the economies of scale," he said. "It needs to be something that's affordable so we're not squeezing businesses out or forcing them into it, so the size of the business is going to be important. What's going to be in the pool — the risk pool, for instance, is going to be important, and the District of Columbia is an example. A lot of that needs to be sorted out, and it needs to be sorted out between now and the end of the year. The time's running very short. Unfortunately, there are going to be a lot of people in the business sector working through the holidays to try and get this implemented in time."
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