By guest blogger Robert Field:
Pennsylvania health care could see major fallout from the upcoming election. The next governor will be in a position to make or break reform in the state. However, the major party candidates have revealed surprisingly little about their plans concerning this volatile issue.
The recently enacted law, known officially as the Affordable Care Act but as “Obamacare” to its opponents, leaves a lot to the states in its implementation. Most importantly, the Act gives states broad leeway in its cornerstone feature, the insurance exchanges. These are marketplaces in which individuals and small businesses will be able to comparison shop and purchase coverage starting in 2014. Each state will have its own, and each can decide how to design it.
Several key decisions will shape each state’s exchange. To start with, how many will there be? Most states will have only one, but large states like Pennsylvania can create more. Next, who will run it? States can choose either a government agency or a nonprofit corporation. Once in operation, exchanges must decide how many insurance plans they will offer and which ones. Perhaps most importantly, they must also determine which customers are allowed to purchase coverage and which ones qualify for subsidies.
Insurance is a complex business, even though it may not always appear that way from the outside. The exchanges face a daunting task in sorting through competing plans to select the menu from which consumers will choose. The next three years will require intricate negotiations with insurance companies and major planning efforts to be ready for the 2014 launch.
In states that decline to implement their own exchanges, the federal government will step in and create them. These are likely to be generic organizations with little regard for local conditions. Their structure and operation will be dictated in Washington, not in the regions where they operate.
The other cornerstone of health reform is a dramatic expansion of Medicaid. This federal-state program for the poor will cover more categories of people at higher income levels. Medicaid is run by each state, so each must do the legwork to implement the changes.
These layers of discretion leave a lot to the judgment of governors and legislators. Their commitment, or lack of it, to smooth implementation will go a long way toward determining how health reform plays out in each state. Tuesday’s election, therefore, could do a lot to set the course for the rollout of health reform in Pennsylvania.
Republican Tom Corbett is a staunch opponent of health reform. In fact, he is one of 19 attorneys general who have joined Florida’s lawsuit seeking to have it declared unconstitutional. Democrat Dan Onorato has said little about his health reform position, but he is not likely to stand in the way of his party’s signature domestic initiative.
Despite the next governor’s key role in shaping health reform in Pennsylvania, the candidates have been surprisingly silent on their actual plans. While each has a detailed health care platform, neither one addresses the implementation of reform. We can guess at their intentions based on past positions, but the attitudes of candidates have been known to change markedly after elections.
In the meantime, Ann Torregrossa, the director of the Office of Health Care Reform under outgoing governor Ed Rendell, is starting to plan health reform’s rollout in the state. However, she has no idea where her efforts will lead under Rendell’s successor. At a recent conference at Drexel University, she expressed frustration at the absence of a serious campaign debate on the issue.
The candidates’ health care positions are markedly similar on those aspects that they do address. Both seek broad efforts to expand access and quality on a state level. The major difference is in Corbett’s commitment to tort reform.
The election will do much to set the course of health reform nationally. Republicans have promised to seek its repeal, and short of that, to challenge the implementation of individual provisions. However, regardless of activity at the federal level, the states will shape reform on the ground. It would be nice if Pennsylvania voters could know before next Tuesday what each of the candidates actually plans to do.
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