NCPA - National Center for Policy Analysis

Health Insurance Exchanges Create State Problems

February 18, 2013

Opposition to state-based health insurance exchanges may be politically convenient in the short term but in the long-term, opposition should rely on a sounder theoretical basis, says Tom Miller, a resident fellow at the American Enterprise Institute.

  • Exchange opponents should root themselves in the fundamentals of choice and free-market competition.
  • Under the Affordable Care Act (ACA), regulatory control of the health insurance market is expanded, which facilitates substantial income redistribution through new taxes and subsidies.
  • The mandate also invokes greater voter loyalty from constituencies who are increasingly reliant on the government to provide health care.

The costs and complexities involved with implementing the state-based health exchanges kept many governors from embracing the new system, which will limit competition from private-market alternatives. The exchanges create the appearance of private-sector delivery but instead create politically favored monopolies.

  • Despite hundreds of pages of regulations, Miller expresses skepticism that exchanges will be free of deceptive marketing, untested mechanisms and unchecked bureaucratic discretion.
  • The Obama administration has reiterated that it will be able to install exchanges in the states unwilling to establish their own.
  • There are doubts about whether federally-created exchanges will be able to track data, handle payments or provide adequate customer service after 2014.

Miller makes three recommendations for those states that oppose the exchanges and for those states that do not want to take the blame when poorly-administered federal exchanges impact their citizens.

  • States should initiate litigation that challenges the Internal Revenue Service's ability to distribute the ACA's premium assistance tax credits to enrollees.
  • States should insist that rulemaking for ACA exchanges operate through more formal and final legal channels.
  • States should refuse to be tax-collecting branch offices for the federal welfare state's new insurance mandate.

Source: Tom Miller, "Bumpy Rise Ahead for Insurance Markets," The Hill, February 12, 2013.


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