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Obamacare has 99 problems - but a Republican governor isn’t one

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From reading the press coverage lately, you could be forgiven for thinking that Republican governors have stopped Obamacare in its tracks.

Chris Christie looks to have vetoed implementation of the the law in

AP

New Jersey Gov. Chris Christie has vetoed legislation to lay the foundation for Obamacare.

New Jersey, as have some Alabama legislators. You may have read about these developments on this very blog (from this very reporter). And you might be wondering: Is the Affordable Care Act dead-on-arrival?

The short answer is no. What Christie and other Republicans are doing is largely political, pushing back against Obamacare by vetoing or voting down laws that help lay the groundwork. But, at the end of the day, the White House holds the trump card: The federal government has promised to step in and set up exchanges in states that do not take on the task themselves.

“If a state says ‘we’re going to pretend the federal government and its laws doesn’t exist,’ I don’t see that being an effective strategy,” says Tim Jost, a law professor at William and Lee University, who supports the Affordable Care Act.

The White House has always said the federal government would set up a health insurance exchange in a state that does not. But states have wagered that logistical challenges could throw a wrench in that plan. If they slow walk implementation for long enough enough, the thinking goes, the feds won’t have the time or resources to make good on the task.

The timeline, after all, is tight: The Affordable Care Act requires each state have a marketplace to be up and running by Jan. 1, 2014. The White House, for its part, it will make sure that happens.

“The Affordable Care Act clearly states that, in January 2014, consumers in every state will have access to health insurance on an affordable insurance exchange,” says Steve Larsen, who oversees the health law’s implementation at the Center for Consumer Information and Insurance Oversight.

To that end, Health and Human Services published a 19-page document today that’s pretty much a playbook for how the federal government will work with states that do not take action. It will work with state Medicaid offices to sort out whether individuals qualify for the program, or for federal subsidies. The feds will provide consumer assistance and figure out which health plans meet requirements to sell on the exchange.

There is certainly a big difference between committing to the task of setting up exchanges - and actually following through. Health policy analysts have questioned whether the feds have sufficient resources for the task in front of them.

“A lot of states will be in a holding pattern until the election,” says Michael Cannon, of the Cato Institute, who has counseled states not to set up exchanges. “The question is, can HHS get states up and running in a year? I don’t see how they can do it.”

Cannon has also questioned whether the federal government has adequate funding to set up exchanges, or the authority to administer subsidies through the marketplaces they oversee.

It’ll be hard to know how well HHS can do at the task, until they actually do it, but the agency does seem cognisant of needing to lighten its workload.

The agency plans to lean on economies of scale, developing the same insurance enrollment system in each state in which it ends up working. Rather than culling a list of the top insurance plans in each state - an approach called “active purchasing” - the federal government has settled on accepting all health plans that meet a checklist of requirements.

“Consumers in every state should be able to have a seamless experience,” says Larsen.

Jost, the law professor, does see some big obstacles in the health reform law’s future: Namely, a Supreme Court decision and a presidential election. Republican states blocking implementation? That’s not one that keeps him up at night. “If a state hangs up everytime the federal government is on the line about this,” says Jost, “I don’t think that’ll be a very effective strategy.”

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