Liberals May Get Wish of National Healthcare Enrollment

Sunday, 01 Jun 2014 05:34 PM

By Greg Richter

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Obamacare foes may have been right all along, as a national registration for healthcare coverage could actually be on the way.

It all started when Democrats, in an effort to combat Republican claims that the Affordable Care Act was merely a backdoor effort at a single-payer system, set up a plan for state exchanges, Politico reports. Court rulings against mandated state exchanges, however, forced the federal government to set up its own exchange for the states that opted out.
States led by Republican governors did opt out, and currently 36 states use the federal exchange at

But Democratic governors who readily jumped on board to create their own exchanges, with federal money, have largely bungled the effort, Politico notes. Eventually, most of those state exchanges are likely to be abandoned for a single federal registration system — just as Republicans warned.

"This was all predictable," Georgia Republican Rep. Tom Price told Politico. "Our friends on the other side didn’t listen."

Price, a doctor, believes more federal control of healthcare is bad for patients. was intended originally as a backup in case a few states had trouble setting up their exchanges. It had little funding and planning. That became evident when the website went live on Oct. 1, 2013 and essentially didn't work.

The website however is now functioning better, but many states have had difficulty setting up effective sites for their exchanges. The most notorious was Cover Oregon,  which folded and is now the subject of a federal fraud probe.

With a few notable exceptions, such as New York and California, many states with their own exchanges are looking to join the federal exchange. Republicans are demanding to know what went wrong.

"While many of these states are simply moving to the federal exchange as a convenient method of alleviating the problems with their own exchanges, it is a short-sighted solution," GOP Sen. Orrin Hatch said. "Nothing is more important right now than for Congress to find out what went wrong and why."

The U.S. system still isn't close to a single-payer method like the United Kingdom and Canada use. Even if all 50 states used the federal marketplace, it is tailored for the needs of each state, which continue to license insurance providers within their borders.

But the move toward a more centralized system more closely resembles what a then-liberal House of Representatives envisioned, Politico notes. Though both chambers were controlled by Democrats in 2009 and 2010 when the legislation was being written, leaders in the Senate won out and got the state exchanges enacted into the final law.

Not all Republicans remain foes of a federal exchange. Republican Kansas Insurance Commissioner Sandy Praeger was once an advocate for state exchanges, but now thinks they are too costly and risky to build.

"I don’t see our state ready to make that financial commitment. I think it would probably not be very practical," Praeger told Politico. She wants Kansas to remain in, but have the national exchange modified to give states flexibility.

She said she believes a federal exchange can eventually be "a comfortable fit rather than an imposed upon, top-down requirement."

Seven states already are doing something similar. The plan was supposed to have been temporary, with the states eventually building their own exchanges. But Politico notes that none of the seven are making any plans toward becoming more independent.

Some lawmakers, such as Democratic Rep. George Miller of California, think more time is needed. His own state's exchange is functioning well, and he believes others can come along.

"It’s not that [states] can’t do it. It’s apparently they didn’t do it right upfront,” Miller told Politico.

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