As John Hood has noted, one of the first important decisions facing new N.C. Gov. Pat McCrory involves the health insurance exchanges tied to Obamacare. The latest issue of National Review offers some guidance on the topic.
Only 18 states have set up health-insurance exchanges under the Affordable Care Act, complicating the implementation of the law. The state-run exchanges are critical to the program, since many of Obamacare’s various mandates and subsidies are implemented through them. The Obama administration promises that the federal government will step in and create exchanges itself in those states that decline to do its bidding, even though the law as written allows federal subsidies only for exchanges set up by the states. The exchanges were created to establish a buffer between Democrats and the effects of the law they passed, pushing economic and political costs onto the states, which would be responsible for creating the exchanges but have little or no ability to control the cost or quality of the insurance sold there. As Pennsylvania governor Tom Corbett put it when refusing to comply: “State authority to run a health-insurance exchange is illusory. When in reality, Pennsylvania would end up shouldering all of the costs by 2015 but have no authority to govern the program.” That’s not an exchange worth making.
