Sarah Kliff reports in Politico today that a number of Republican governors are moving forward with setting up exchanges:
In Indiana, Gov. Mitch Daniels issued an executive order that allowed the state to become one of just three to receive a multimillion dollar grant to establish a health exchange, the online insurance marketplaces that all states must eventually have if the reform law stands up in court.
Wisconsin, under the leadership of Gov. Scott Walker, is one of six states to win an Early Innovator grant. While the grant was received under Walker’s predecessor, Gov. Jim Doyle, Walker has continued to use the resource, setting up the Office of Free Market Health Care that has prominently advertised its innovator status.
And in a weird twist of politics in Mississippi, state agencies of Gov. Haley Barbour have relied on little-used statutory authorities to set up an exchange, reviving a Democratic-sponsored effort to do so through the Mississippi State Legislature.
This is a nice bookend to her piece from two months ago discussing how many states were refusing to move forward.
It’s not hard to understand the competing rationales behind these moves. For those who oppose the PPACA, or believe it to be unconstitutional, doing anything to support the law can be problematic. However, refusing to prepare the exchanges is a real risk. It’s unlikely the law will be repealed soon. Should it not be found unconstitutional and thrown out entirely, the exchanges will still stand. The PPACA clearly says that if a state doesn’t have an exchange, then the federal government will create and run one for it. It’s going to take some time to set one up, and if 2014 rolls around and states don’t have an exchange ready, then it will be the feds, not locals, who will dictate terms.
For many Republican governors, losing states’ rights should be very, very unpalatable. Moreover, once control of a state’s exchange is ceded to Washington, it’s going to be difficult to get it back.
It’s a political gamble these days for a Republican governor to do anything to implement the PPACA. But it’s likely a bigger gamble to do nothing.
Aaron Carroll is a pediatrician, health services researcher and associate professor of pediatrics at Indiana University School of Medicine. He blogs at The Incidental Economist and tweets via @aaronecarroll.