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Monday, May 21, 2018
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A better way to exploit Obamacare

Republicans have responded to the delay of an important component of President Barack Obama's health-care reform by escalating their attacks. Here's a suggestion: Instead of trying to wreck the law, focus on using it to prove the superiority of conservative principles. The Affordable Care Act offers states enormous flexibility in carrying out its two main elements: the creation of insurance exchanges and the expansion of Medicaid. The White House, desperate to bring more states on board, has entertained a range of conservative proposals. In Idaho, Butch Otter is one of just a handful of Republican governors to set up insurance exchanges on their own or in partnership with Washington. Its design will reflect Idaho's small-government philosophy - providing a minimalist, streamlined approach, potentially offering a stark contrast with the bells-and-whistles exchanges envisioned by neighboring Oregon and nearby California. The state expects two benefits. Its exchange is more likely to be up and running on time, and its low overhead costs will be passed on to insurers in the form of lower assessment fees. That, in turn, may lead to lower premiums for people buying insurance.
Another example of using the law to test conservative ideas is taking place in Arkansas, where the Republican-led legislature allowed Gov. Mike Beebe, a Democrat, to seek new federal Medicaid money on the condition that funds be channeled through the state's new exchange. The state's Republican House speaker, Davy Carter, called the idea "a conservative alternative to the policy forced upon us by the federal government." The approach should yield lessons for Republicans and Democrats alike. Iowa is undertaking a slightly different experiment. After first refusing to accept federal dollars to expand Medicaid, Republican Gov. Terry Branstad offered to take the money on the condition that a portion of government premium payments would be tied to the behavior of beneficiaries. Under the state's proposal, Iowa residents with low incomes in a specified range will get insurance through the exchanges; as in Arkansas, federal Medicaid dollars will pay the premiums. Here's the twist: Beneficiaries will have to meet a series of health-related requirements, such as getting annual physicals or diet counseling, or else pay a portion of their premiums. None of these Republican variations are guaranteed to succeed. That's the point of experiments. Sometimes they fail, and you learn as much from failures as from successes.
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