GOP Governors Unwittingly Move U.S. Toward Single Payer Health Care

Republican governors are holding a boycott. As the deadline looms large for them to establish state-based exchanges, they are refusing to do so, one after the other.

I applaud them. No, really. I do.

For those of you who might have followed the entire Obamacare battle from July, 2009 to March, 2010 -- start to finish -- you may recall that the House bill originally called for a national insurance exchange based on national risk pools rather than smaller, state-based ones. This was always a good thing, because the broader the risk, the less cost each individual has to bear.

Then Max Baucus wasted all sorts of time and energy concern trolling over the possibility that states would sue the federal government for pre-emption of states' rights, and so the Senate version was born with state-based exchanges.

I always hated that idea, because it limited risk to a much smaller pool and had the potential to drive up the costs, but the counterargument was that it was good-faith evidence that the legislative intent was not to override states' decisions.

Also, as you may recall, the alternative to the public option was a federally-run exchange with products negotiated by the OPM in the same fashion as the Federal Employees' Health Plan (FEHP), which had far more competitive rates than any state plan I could find to compare.

When these Republican governors opt out of the state-based exchanges, they are not opting their states out of Obamacare. I'm sure they're trying to set up future litigation as yet another roadblock, but fortunately there were safeguards written into the law in order to thwart effective "secession" from the coverage rules.

Each of those Republican governors has just abrogated their authority over the insurance exchanges to the federal government, who is now free to step in and offer people in their state health insurance based on a national risk pool, rather than state based. The bigger the pool, the cheaper it is.

Insurers are already whining about how they'll be out of the health insurance business altogether in a matter of a few years. Good. This should hasten the process and bring about single payer that much faster.

So why are they doing this? What benefit is there in opting out? Well, there's political benefit. They get to stand on the principle of not bending to the will of the people and implementing a law which is a law. I suppose they could point to Medicaid and their reluctance to avail themselves of federal funds there, too. It's also possible that they will try and use the one piece of the June Supreme Court ruling about Medicaid to justify their opt-out of the entire program.

But Obamacare is the law of the land, and people in those states are entitled to health coverage, and the federal government will ensure they have those options. If these governors want to surrender their state sovereignty to regulate and create the exchanges, the federal government has the authority to do it, will do it, and will leave the GOP governors out flapping in the wind as the selfish, cynical, cruel lot that they are.

So you just keep right on being obstinate, GOP governors. It means we'll move to the next square that much faster and be opening Medicare up that much sooner. After all, if we don't have states whining about their rights, it's that much easier to pre-empt it all in favor of a federal program.


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