Editorial: Health Exchange

Two strong impressions emerge when reading about the deadlines and decisions that New Hampshire now faces in implementing the Affordable Care Act: The legislation, despite its reputation as an egregious example of federal overreach, is extremely solicitous of state prerogative; and New Hampshire is likely to regret the position on the health care law staked out by extremists in the Legislature that is now thankfully expiring.

A major step in the rollout of Obamacare, as the Affordable Care Act is better known, is the establishment of health exchanges — virtual marketplaces where individuals and businesses can review and choose from a range of insurance options. States have their own range of options in that regard: They can run their own exchanges; they can cede the entire job to the federal government; or they can opt for a hybrid model in which they work with the federal government to run an exchange. Among the reasons that states might want to retain a role is to preserve some influence in determining what sort of benefit packages are offered.

The health exchanges won’t be running until October, but New Hampshire has only until Feb. 15 to determine its level of involvement. If that seems like precious little time to make an important decision, don’t blame the feds. States have been aware of the deadline since Obamacare became law in 2010. Vermont, for example, decided early on to set up its own exchange and used the past year to debate how to do that.

New Hampshire Republicans, by contrast, regarded the phased implementation of the ACA not as an opportunity to expand access to health insurance but to posture against what they regarded as a federal takeover of health care.(It must be said that this takeover seems to go out of its way to carve out a role for states in running exchanges, which invite competition among private health insurers.) Anyway, the Legislature passed a law that prohibited the state from running a health exchange, even though such a ban simply meant that the big bad feds would do it instead. And, as staff writer Chris Fleisher reported in the Sunday Valley News, legislators also enacted a measure requiring the state to return two-thirds of a $1 million federal grant to study how the state’s health insurance industry would be affected and to educate the public about health exchanges. When the state’s insurance department wanted to use the remaining $300,000-plus of the grant, it was blocked by the all-Republican Executive Council, which voted that that money must also be sent back to Washington.

Had opponents of the law behaved sensibly, they would have acknowledged the possibility that the law would remain on the books and taken steps to establish a state-run exchange as a way to protect state influence. As Fleisher reported, a proposal to set up a state exchange as a way of preserving the private marketplace — proposed by a Republican state senator who was hoping Obamacare would be struck down or repealed — was rejected. A majority of Republican legislators apparently regarded it as repugnant because it implicitly recognized the legitimacy of the federal law.

Now, the state is stuck with a very tight deadline for deciding what to do; must quickly repeal the law prohibiting a state exchange if it chooses to run an exchange; is left with little time to design an exchange; and, oh yes, has lost a federal grant that would have come in handy for initial planning. Such is the price of ideological purity.