Now that Obamacare has been upheld by the Supreme Court, and President Obama himself re-elected to a second term as governor, the voices of those clamoring for the states to begin implementing Obamacare are getting louder.
Here in North Dakota the state legislature, and Governor Jack Dalrymple, have wisely decided to resist implementing the state health insurance exchanges included in the law. These exchanges are touted as an element of “local control” by Obamacare’s supporters, but in truth there’s no local control to be had at all through the exchanges.
“[A] state-created exchange is not a state-controlled exchange,” writes CATO health policy expert Michael Cannon for National Review. “All exchanges will be controlled by Washington.”
So what does a state-created exchanges do for the states? Implementing a state-level exchange could cost each state doing so millions, even hundreds of millions of dollars, all of which must come from state revenue sources (i.e. your state taxes). What’s more, local policy-makers implementing the exchanges would, after their creation, likely take the blame for the inevitable increases in health insurance costs.
Policy for the exchanges, remember, would continue to be set in Washington DC, meaning local policymakers would be taking the blame for policy created somewhere else.
Also, because the Obamacare law only allows for the federal government to subsidize health insurance policies through state-created exchanges, states refusing to implement Obamacare can throw a monkey wrench into the law’s implementation.
Finally, states refusing to implement exchanges will also be exempting citizens and businesses within its borders from Obamacare’s insurance mandates. As Michael Cannon writes, “defaulting to a federal exchange exempts a state’s employers from the employer mandate — a tax of $2,000 per worker per year.”
If all states did so, that would exempt 18 million Americans from the individual mandate’s tax of $2,085 per family of four. Avoiding those taxes improves a state’s prospects for job creation, and protects the conscience rights of employers and individuals whom the Obama administration is forcing to purchase contraceptives coverage.
After the legal challenge to Obamacare failed in the federal courts, and with Obama winning re-election, Obamacare may seem inevitable. That’s certainly the message Republicans in US Congress seem to be sending. But be that as it may, the states can still avoid a lot of bad policy (and a lot of additional spending burdens) by refusing to implement the law.
North Dakota needs to stay strong in resisting Obamacare.