Georgia puts health effort on feds

Republican governors have emerged as perhaps the greatest remaining hurdle to President Barack Obama’s health care overhaul after a landmark Supreme Court ruling that preserved its major points.

Georgia Gov. Nathan Deal and other opponents blazed a trail for the opposition more than a month ago by refusing to set up a state-run health insurance exchange, making the state one of the first to refuse this key step toward implementing Obamacare.

More than 30 states — most with GOP leaders — have now opted against taking full control of their insurance exchanges. The move forces federal regulators to set up the insurance systems instead.

Instead of state leaders making key decisions, federal officials will determine details of how exchanges operate — from who governs them to which health plans will be sold at the online marketplace.

Experts say a consumer’s experience using an exchange will likely be similar no matter who runs it. Georgia Democrats argue that Deal has sacrificed any influence the state could have on operating the system and placed politics over the needs of Georgians.

The exchange website is expected to serve roughly 900,000 Georgia residents when it launches in 2014 — allowing individuals and small businesses to compare the quality and prices of health plans.

Deal views Obamacare as an intrusion by the federal government. In refusing to set up the exchange at the state level, he won points with conservative supporters who fear the law places a costly new burden on states and gives bureaucrats too much control.

Deal said in an exclusive interview with The Atlanta Journal-Constitution the move wasn’t a delaying tactic. Instead, he said, it was a rejection of a program he viewed as so heavily regulated that it prevented the state from forging an exchange tailor-made for Georgia’s needs.

“It’s not our goal to thwart Obamacare,” Deal said. “But it’s a matter of saying we don’t have enough information — and the information we do have doesn’t lead us to the conclusion that it benefits the state.”

The resistance is unlikely to sink Obama’s overhaul, but shifting the burden to the White House could slow the process and buy states time to demand more flexibility with the regulations.

“The practical effect is that the federal government isn’t prepared to run these exchanges either,” said Deal.

Federal officials say the timeline to have exchanges up and running by Jan. 1, 2014, hasn’t changed. But they will be on a tight timeline to create dozens of exchanges, which are slated to begin enrolling people next October. Websites must be built and customer help hotlines set up. Health plans must be certified and board members chosen to oversee the exchanges. Information technology systems must be streamlined and interconnected to ensure people are directed toward either exchanges or government health programs such as Medicaid if they qualify.

State Rep. Pat Gardner, an Atlanta Democrat who is one of her party’s experts on health care law, said the exchange will require complicated new risk-management formulas.

“It’s very disappointing to me that rather than figure out how to make the exchange work for Georgia citizens, we’re finding ways to continue to resist, which I think is unfortunate,” she said.

Other supporters of the health care changes see a silver lining in the GOP strategy.

“It may be better to have an exchange that’s built out by the Department of Health and Human Services that’s designed to make the process better for consumers than an exchange that’s twisted in knots to try to avoid the goals of the law,” said Cindy Zeldin, executive director of Georgians for a Healthy Future, an advocacy group.

The exchanges are a key part of the health law’s promise of guaranteeing access to insurance coverage for millions of uninsured Americans. People who don’t have coverage through an employer, and who don’t qualify for Medicare or Medicaid, could shop for health insurance through an online marketplace, and insurers would offer an array of plans to better spread the risk.

Deal announced in mid-November that Georgia wouldn’t make its own exchange, denouncing it as a program “that is state-based in name only.”

“It was designed to be a uniform application of health care benefits across the country,” said Deal in the interview. “And that is an idea that, quite frankly, is foreign to everything that is in place to insurance in general and health care in particular.”

People in the insurance industry say a state-built exchange would have been better able to respond to changing market forces unique to Georgia, such as shifting population demographics and regulation changes. The state would have been eligible for federal grants to set up the system and also have had some flexibility to determine how it would operate, they say.

As the government pushed back the deadline to December to give more time to wavering governors from other states to follow suit, pressure intensified on other GOP governors to follow suit.

By Dec. 14, the deadline to decide on the program, even some Republican officials who publicly considered cooperating with the White House reversed course.

Among them were Virginia Gov. Bob McDonnell and Tennessee Gov. Bill Haslam, who both said their states wouldn’t run their own exchanges after months of preparing to do so. Both men said Washington gave them too few directives on operational issues.

At least five Republican state officials have said they would establish a state-run marketplace, hoping to retain local influence over the law’s effect. In all, 18 states and the District of Columbia have agreed to set up the systems, according to the nonprofit Kaiser Health News media service. States not creating state-based exchanges still have until mid-February to decide whether to partner with the federal government on one. They could also decide to take over in the future.

Even though Georgia has ceded control to the federal government, state health officials still have work ahead. New rules under the exchanges will have to be reconciled with existing state regulations that already govern health insurance markets.

The exchange decision was celebrated by Deal’s supporters as he enters the crucial third-year of his gubernatorial term.

The Georgia Tea Party, one of several loosely organized fiscal conservative groups that sprang up in opposition to the health care overhaul, exhorted its members to thank Deal for rejecting “this unprecedented intrusion into a state responsibility.”