Yesterday I wrote that Governor Jack Dalrymple had gone wobbly on his past opposition to implementing the Obamacare exchanges in North Dakota. Shortly after I wrote that post comments from House Majority Leader Al Carlson were reported which makes it sound like he’s second-guessing the decision to oppose exchanges too.
I’m not sure how much to read into these comments as legislators I’ve spoken to are pretty confident in continued opposition to the exchanges in both houses of the legislature, and Carlson is prone to putting his foot in his mouth, but for what it’s worth:
BISMARCK, N.D. — North Dakota’s House Republican majority leader says the Legislature may revisit whether the state should take part in running a new health insurance marketplace that is a key part of the new federal health care law.
Lawmakers rebuffed a proposal for a state-run “health exchange” a year ago, when many Republicans hoped the U.S. Supreme Court would throw out the law — or that this year’s elections would lend momentum to efforts to repeal it.
Neither happened, and lawmakers may have to rethink their next moves, said Rep. Al Carlson, R-Fargo, the majority leader.
“I don’t think there’s any question we have to analyze what our options are,” Carlson said. “Now, I don’t see any hope of (the federal health care law) being changed in Congress.” …
Carlson said that stance could be reconsidered. One option, he said, would be to explore what the federal Department of Health and Human Services calls a “state partnership exchange,” which would allow some state management of the system.
“If we’re forced to have something, I would think we would look at state exchange (administration), instead of the federal side,” he said.
These North Dakota Republicans who are suddenly on the fence about the exchanges might want to take a look at Wisconsin Governor Scott Walker’s letter to Secretary of Health Kathleen Sebelius indicating his state’s decision to oppose the exchanges.
“The Patient Protection and Affordable Care Act (PPACA) gives states three options in building health insurance exchanges: an exchange built and managed by an individual state subject to federal mandate; a partnership plan requiring the state to perform functions on behalf of the federal government; or a federal exchange developed by the federal government,” wrote Governor Walker. “While the three options differ in who initially builds and operates the exchange, all three options are identical in that they are governed and controlled by federal policy. No matter which option is chosen, Wisconsin taxpayers will not have meaningful control over the health care policies and services sold to Wisconsin residents. If the state option is chosen; however, Wisconsinites face risk from a federal mandate lacking long-term guaranteed funding.”
The situation is the same for North Dakota. There is no “local control” in the Obamacare exchanges. However the exchanges are implemented, the federal government remains in the driver’s seat, and the only real choice states have is whether or not to obligate themselves for paying a big chunk of the cost of the exchanges.
That’s something North Dakota must say “no thanks” to.