(Note: This is the second of a two-part interview series with John Graham of the Pacific Research Institute and Christie Herrera of the American Legislative Exchange Council.)
In Idaho a debate rages about whether the state should set up its own exchange or let the federal government take on the task.
Two health policy experts say it really doesn’t matter who does the job.
John Graham of the Pacific Research Institute, a California-based think tank, and Christie Herrera of the American Legislative Exchange Council, told IdahoReporter.com Thursday that they believe there’s no difference between a state-based exchange and a federally run program.
The duo was in Boise Thursday to meet with lawmakers about exchanges. There trip was funded by the Idaho Freedom Foundation.
“The secretary of Health and Human Services (HHS) in Washington, D.C., can dictate every regulation that your state health insurance exchange is going to be implementing,” Graham said. “So it’s an absolute myth that you can build some kind of firebreak or firewall or barrier. It’s an absolute myth.”
Graham believes that if the U.S. Supreme Court decides in June that the Patient Protection and Affordable Care Act (PPACA), the law from which exchanges are derived, is constitutional, then federal rules and regulations take pre-eminence over anything the state wants to put into place.
“There’s no way your local authorities … is going to have any influence over the rules,” Graham warned. “Obamacare will be supreme and all the money is going to come from Washington, D.C., and power follows money.”
Herrera echoed Graham’s notion, saying that she also feels there’s no difference between a state and federal exchange. “We know that HHS has to approve every detail of the exchange,” Herrera said. “There are several factors that have come out that show there’s no such as a state exchange, only a federal exchange that’s administered and paid for by the federal government.”
But, Herrera says there’s also a misconception that the federal government will automatically implement an exchange if the state doesn’t. She says that technical provisions in the PPACA don’t allow the federal government to spend money on building state exchanges.
Herrera also says that there may not be authorization for insurance subsidies to flow through federally built exchanges.
There is also skepticism about the deadlines created by HHS for exchange creation. The first benchmark, set for Jan. 1, 2013, says exchanges must be certified by that date, though there are few details as to what certification entails.
Others believe exchanges must be operational by Oct. 1, 2013. There is also talk, however, that states slow to implement exchanges might be OK creating them by Jan. 1, 2015.
“Over the past six months, HHS has made a number of statements that show their deadlines really aren’t deadlines at all,” Herrera warned. “These HHS deadlines are moving targets.”
Video for the series by Mitch Coffman, IdahoReporter.com.