The trouble is that one state’s progress is often considered a treasonous betrayal by others – think Rick Perry and Ben Bernanke. Here we have this pesky law called the Affordable Care Act that no one in the Republican camp likes. As proof of this, twenty-six US states have challenged the law as unconstitutional. The Supreme Court has accepted the case and it will be heard sometime during the next nine months. The reason why this makes the Act pesky is because it’s actually a part of the law unless and until the Supreme Court rules it unconstitutional. Contained with the statute is a timetable and it’s ticking away. This creates a dilemma for the Republican states. This timetable is not going to be rewritten so, if the Act is upheld, the states that have failed to take the steps towards implementation could suddenly find themselves losing control of the process.
Each state must have a working exchange in place come 2014. Note this is not a requirement simply for a proposal or a detailed specification. The actual exchange must be up and working. That means commissioning the design now, allowing plenty of time for the coders to work their magic and then debug until the exchange actually works. Most experts take the view this is getting close to the deadline for beginning the work if a properly tested exchange is to be ready in time. This is reinforced by the federal government which is providing funding support on a use-it-or-lose-it basis. If states have a viable plan and greenlight the project, they get the money. The latecomers either pay for the work out of their reserves (not a good thing given most states are running a deficit) or they accept the electronic exchange provided by the federal government.
As an example of how some states are approaching the problem, let’s look at Illinois. Lawmakers are now considering a bill to approve work on the exchange and, equally important, to create the management structure to oversee the operation of the exchange once it’s up and running. The bill calls for the initial work to be complete by June 2012 which is the deadline for access to federal funding – estimated to be about $150 million for the hardware and software. Because of pressure on the state budget, the unanswered question for now is who will be responsible for paying the administrative costs of the exchange after 2014. Independent experts estimate this will be about $75 million per year. As the Affordable Care Act is written, it appears this must be paid by the state but it’s possible new regulations could change this.
While we wait for all this to become more clear, the latest estimates for the cost of insurance through the exchange are encouraging. Taking current reality, some 1.7 million are uninsured and a floating population of 1.4 million is expected to use the exchange. Assuming about 1 million become steady users within the first two years, the health insurance plan would cost about $12 per month. If the poor were to be charged extra to cover the administrative costs, this could make the insurance significantly less attractive. This will genuinely be cheap health insurance for the poor of Illinois and a good model for all to follow.
