I wrote earlier this week wondering if, now that the Supreme Court has upheld the law and Barack Obama has won re-election, North Dakota governor Jack Dalrymple would maintain his opposition to implementing the health insurance exchanges here in North Dakota.
Dalrymple was pretty adamant in his opposition last year, saying there were too many unknowns for the state to get involved. In an article published today, Dalrymple makes it sound like he’s open to a federal exchange:
“Gov. Dalrymple has kept an open mind to what will be the best solution for North Dakota, including the option for an exchange that is jointly managed by the state and federal government,” Jeff Zent, the governor’s spokesman, said Wednesday.
In related news, it does appear as though recently re-elected Insurance Commissioner Adam Hamm is maintaining his opposition to the law. He, along with a representative for Governor Dalrymple’s office, testified at a legislative committee last year opposing implementation of the exchanges:
“Let the federal government prove to North Dakota and to other states that exchanges can work financially,” Hamm said in a statement. “If the federal government can prove that, North Dakota could, if it wanted to, take over the exchange operations at some point in the future.”
That makes it clear where Hamm is at. Let the feds implement the exchange. If it’s such a wonderful idea (and it won’t be), the State of North Dakota can take it over later.
Let’s be clear: The exchanges are a crap sandwich. They are the creation of a controlled market for health insurance, and regardless of who implements them, the federal government is in the driver’s seat in terms of what insurance policies can and cannot be sold on the exchange. If the federal government doesn’t like the terms of a particular policy, be it sold through a state-implemented exchange or a federal-implemented exchange, the federal government can reject it.
There is no state control. All the state implementation allows for is the state of North Dakota to take on a significant amount of the cost for implementing the exchange.
Paying for something the state doesn’t control doesn’t sound like a good deal for the state.
In North Dakota, insurance giant Blue Cross Blue Shield is the primary force behind the push to implement exchanges at the state level. For BCBS, the exchanges represent a government-controlled market for the products they sell. They seem to think that they may have a bit more advantage if the exchange is implemented by policymakers in their back yard rather than in Washington DC.
That may be true marginally, and maybe state implementation is better for BCBS, but it’s not better for insurance consumers or the taxpayers.
Update: I made some phone calls to some legislative friends today, and the consensus is that the Republican caucus (especially the House Republicans) don’t see exchanges going anywhere. There might be some different feelings if the federal government makes some reforms to the Obamacare policy, but as it stands now exchanges seem to be a non-starter from the legislative perspective.
Update: A reader forwards along this response from Governor Jack Dalrymple’s office to a question about whether or not they support the exchanges. Note that while the response notes the legislature’s past vote against implementing exchanges, it tells us nothing about Dalrymple’s position.
Thank you for your email regarding the health benefits exchange and Medicaid expansion provisions of the Affordable Care Act (ACA). The North Dakota State House of Representatives voted 64 to 30 to defeat efforts to establish a state-based, ACA mandated exchange. Therefore, North Dakota will not be building a health insurance exchange.
Constituent Services Director
Office of Governor Jack Dalrymple