To Exchange Or Not To Exchange? That Is Today’s Question. UPDATE: Deal Says No Thanks

November 16, 2012 11:49 am

by Buzz Brockway · 83 comments

Among the requirements placed on States by the Patient Protection and Affordable Care Act (PPACA, or Obamacare) is that States are encouraged to create and run a health insurance exchange. States must notify the federal government of their intention or lack thereof in creating State run health insurance exchanges. Today is the deadline for that notification.

Governor Deal has indicated he will not seek to create PPACA health insurance exchanges, telling 11Alive last week:

“We’ve pretty well indicated that we don’t like the way that the program has evolved. It started out (that) the states were given some real options to how we designed our state exchanges. Those options have been pretty well removed by regulation over the last year and a half,” Deal said Thursday.

So what happens if Deal does indeed tell the Feds “thanks but not thanks?” According to this study, Georgia residents who qualify to purchase insurance through the exchange could lose tax credits that would have been available to them if the exchange were run by the State.

Health insurance exchanges in and of themselves are not a bad idea. However, as the Governor points out, the Feds have limited our flexibility in regard to the exchanges. That’s a shame.

Deal is not alone in his reluctance to create health insurance exchanges. Governors of 16 other States have either formally announced or are expected to announce they will not create exchanges. At a meeting of the Republican Governor’s Association this week discussion on Obamacare are taking place. Some are urging the 30 Republican Governors to not only reject the exchanges but to also reject expanding Medicare:

Some conservatives are urging the governors not only to stay out of the exchanges but also to reject Obamacare’s planned expansion of Medicaid. That could be a crippling blow to the health care law. “If enough states do so, Congress will have no choice but to reopen Obamacare,” Cato Institute health care scholar Michael Cannon wrote in National Review Online recently. “With a GOP-controlled House, opponents will be in a much stronger position than they were when this harmful law was enacted.”

The medicaid expansion decision is coming but health insurance exchanges are the decision that must be made today. I predict Governor Deal will notify the Obama Administration that Georgia will not create it’s own exchange.

UPDATE: Governor Deal sends letter to HHS Secretary Sebelius saying Georgia will not create health insurance exchange.

“We have no interest in spending our tax dollars on an exchange that is state-based in name only,” Deal said. “I would support a free market-based approach that could serve as a useful tool for Georgia’s small businesses, but federal guidelines forbid that. Instead, restrictions on what the exchanges can and can’t offer render meaningless the suggestion that Georgia could tailor an exchange that best fits the unique needs of its population.

Full press release below the fold.

For immediate release Office of Communications
Nov. 16, 2012 (404) 651-7774

ATTACHED: Gov. Deal’s letter to HHS Secretary Sebelius.

Deal: Georgia will not set up state exchange
Governor cites unknown costs, lack of flexibility in Obamacare’s federal regulations

Gov. Nathan Deal today informed the Obama administration that Georgia will not set up its own health care exchange, citing Obamacare’s one-size fits all approach and the high cost that the law places on states.

“I remain committed to common sense health care solutions that empower consumers to take responsibility for their own health, motivate the private sector and drive efficiencies for consumers, employers and governments alike,” Deal said. “I continue to hope that we might finally engage in a serious conversation about restoring meaningful flexibility to states around health care programs.”

Deal said the federal government needs to loosen regulations that restrict states’ options.

“We have no interest in spending our tax dollars on an exchange that is state-based in name only,” Deal said. “I would support a free market-based approach that could serve as a useful tool for Georgia’s small businesses, but federal guidelines forbid that. Instead, restrictions on what the exchanges can and can’t offer render meaningless the suggestion that Georgia could tailor an exchange that best fits the unique needs of its population.

“I have joined numerous other governors seeking guidance from the federal government on establishing exchanges. We’ve yet to receive serious answers to our questions. I will not commit Georgia taxpayers to a project with so many unknowns.”

griftdrift November 16, 2012 at 12:07 pm

When crazy Rick Scott in Florida is agreeing to something and you’re not, it might be time for a second thought. Just sayin.

Chris Huttman November 16, 2012 at 12:09 pm

The Medicaid expansion, paid for 100% for a few years and then 90% after that by the federal government, is money that Georgia and her people desperately need. It’s a direct infusion of money into our healthcare economy worth $40 billion, and many of our largest hospitals (which currently lose hundreds of millions each year treating patients without healthcare) have already agreed to national reimbursement rate cuts under the assumption that they’d have access to this pool of money. In addition, the economy of Georgia and everywhere else depends on a mobile workforce of lower paid employees to keep cranking. If someone making $25,000 can choose to live here or in a state that does the Medicaid expansion, they will choose to live elsewhere, which will drive up the cost for employers of finding quality labor in this state.

It’s literally a no brainer. But you need even less of a brain to set up an exchange here. The exchange is coming whether Georgia Republicans like it or not. They can have a hand in designing it and how it runs or they can choose to cede power to the feds who will do it for them. Let’s not forget that we’re talking about an EXCHANGE here, the same kind of marketplace that Republicans are always preaching – sure it isn’t a perfect free market, it is obviously regulated (the same way car insurance is in Georgia), but that pretty much spells it out.

The American people have loudly spoken in favor of changes to the healthcare delivery structures. About 45% of them are ok with Obamacare as it is (they don’t want to repeal it) but the mistake Republicans seem to be making is thinking that the other 55% uniformly want to repeal it and replace it with some mythical Republican alternative (which, btw they didn’t deliver when they had the chance). In actuality that other 55% is maybe a hardened 35% that’s against any change and a floating 20% that agrees in principal with the changes that Obamacare made (including things like a state marketplace/exchange and an expansion of Medicaid to give coverage to those who don’t have it) but maybe want to make some minor changes.

So Republicans: embrace the 65% that either like the law or support it in principal and show how you can bring constructive solutions and changes, or pander to your 35% and lose the 20% that are currently willing to hear your ideas. Your choice.

Brian November 16, 2012 at 5:10 pm

It’s a myth/bluff that the federal government will setup an exchange if states say no thanks. There is no existing funding for health exchanges. Funding would have to be chartered by a GOP House of Representatives, which has voted to repeal Obamacare 3 times. Get your facts straight.

Also, the existing Medicaid program covers about 48 millions Americans, or 16% of the population, according to the Kaiser Family Foundation. In July, the Supreme Court, by a 7-2 vote, ruled that states don’t have to participate in a huge expansion of Medicaid, the state-federal insurance program for the poor, called for in the ACA. (The ACA was written so that states that decided not to expand their Medicaid programs would lose their existing Medicaid funding, but the court said funding already in place should not be affected by states’ decisions on the ACA changes.) The High Court ruling left this expansion vulnerable, and along with it the law’s promise to bring the national insured rate to over 90%.

Dave Emanuel November 16, 2012 at 12:10 pm

It is truly unfortunate that there is so much misinformation about the exchanges. Many people have mistakenly assumed that Governor Deal is taking a political stance in saying he won’t sanction an exchange. From what I’ve seen, he’s taking a non-political stance and is serving the best interests of all state residents. Of course, if you believe that health care is a right, to be administered by the federal government and funded by tax revenues, incorrect information is nothing more than a minor bump in the road to “free health care”.

Chris Huttman November 16, 2012 at 12:21 pm

What an ridiculous response. Do you get healthcare from your employer pre-Obamacare, then guess what, it WAS and CONTINUES to be funded by tax revenues, as your employer takes a deduction from their income to provide it as a benefit.

Oh, are you part of the 20% of the country that is on or will soon be on Medicare – then guess what that’s federally funded too.

So, either you’re suggesting that we radically change how healthcare is paid for and delivered in this country – which I think you’re smart enough to know there isn’t a chance in hell is happening, or you’re being intellectually dishonest and pretending that changes to the healthcare system like an exchange are somehow inconsistent with how we’ve been doing things for the last 50 years and are some sort of mad cap socialist encroachment.

The exchanges are a CATO idea, and now CATO says take a stand against our idea to save the country or win back the Senate or some other longshot BS theory? So stupid.

I support Obamacare, and the exchanges, but I will be the first to admit that as this law is implemented – like any law or plan – changes will need to be made. You Republicans can live in a fantasy world (as you seem to have chosen) where you do things like pretend that the government wasn’t involved in healthcare pre-2009 until Obama took over, or you can decide to live in the reality world and offer constructive changes and criticisms that will benefit a majority of Americans. Unfortunately a majority of Americans don’t provide 51% of the votes in a Republican primary and that is clear from these discussions.

The Republicans of 2012 really are in the same position as the Democrats were circa 1988. I pray for the future of this country, which really needs a sane and competitive two party system, that you guys have a Bill Clinton out there that can communicate equally well with your base and with moderates and independents to provide a future framework that works both for your party and America, as we really are ultimately all in this thing together.

Harry November 16, 2012 at 12:28 pm

You think the GOP needs (God forbid) a “Bill Clinton”, whereas you guys have a weak angle-shooter, a BS-er, a panderer to the lowest common denominator, a Chicago partisan hack community organizer who only knows how to game the system in a very superficial way.

Chris Huttman November 16, 2012 at 12:29 pm

Ok we also have a two term President who got a majority of the vote (greater than 50%) twice, we have 55 Senate seats, and we are at about 48% in the house despite the fact that we got a majority of votes in house races. So yeah maybe you do need a Bill Clinton type if you can’t even prevent a weak angle-shooter, BS-er, panderer to the lowest common denominator and Chicago partisan hack community organizer from winning twice.

Harry November 16, 2012 at 12:47 pm

So all you have is a snide remark. I’m not saying my side has all the answers, but you ignore the real reason for the Dem success – superfluous corporate media propaganda promoting the choice that serves their ideological and business interests.

Chris Huttman November 16, 2012 at 12:50 pm

Your initial remark was snide. A majority of the country wants to move in the direction that Obama and the Democrats present. There has never been as coordinated of a campaign as Republicans made to present how clearly they object to this over the last four years, and the voters chose sides, and it wasn’t yours. You can keep pretending it’s because of Obama’s mythical ability to con enough segments of the electorate and not because of the own structural problems with your party and ideology.

Harry November 16, 2012 at 1:29 pm

I ignore whatever advice a partisan Democrat presumes to give the GOP.

Trey A. November 16, 2012 at 1:40 pm

Maybe you should take Bobby Jindal’s advice instead. Itty-bitty tent ain’t working. Chris is right.

Harry November 16, 2012 at 1:47 pm

Yet more unneeded advice from a Democrat. By 2016 Zero’s stock will be Zero. The GOP doesn’t need to become Democrat Lite losers. Won’t happen, no matter how much you wish it. The people decide, not a bunch of political hacks.

kyleinatl November 16, 2012 at 2:56 pm

And the people decided they don’t want what you’re selling, the results speak for themselves. Time to sell a slightly better product or risk irrelevancy. That base ain’t getting any bigger.

Harry November 16, 2012 at 4:11 pm

Don’t count on the same results in 2014 and 2016, even with the media on your side.

kyleinatl November 16, 2012 at 4:31 pm

Again, you need to find a way to expand your base, cause it is shrinking. I don’t think I need to explain why.

Harry November 16, 2012 at 4:35 pm

Thanks for your concern and advice. BHO will see to it that the GOP base expands on it’s own without your help.

kyleinatl November 16, 2012 at 5:18 pm

Oh Harry, you just don’t get it, but that’s fine, that kinda thinking is to our benefit.

Enough Threadjacking from me. Have a good weekend!

Brian November 16, 2012 at 5:27 pm

IMO, the GOP “establishment” IS trying to become Democrat Lite in order to retain power in a hard left media. Just look at the past two Presidential candidates they ran. Neither were right of center prior to their General Elections. Then they moved slightly right of center in an attempt to get some of the GOP base, but not too far so as to minimize media attacks. That NEVER works!

Brian November 16, 2012 at 5:23 pm

The problem is not Conservative ideology, the problem is the GOP’s watering down of Conservatism. In the past two Presidential races, neither McCain or Romney had enough balls to paint the true distinctions between Progressive (European Socialist/Marxism) and Conservative (Constitutional belief in personal responsibility and truly limited government) ideologies. Both GOP candidates were afraid of the hard left media and moderates. Moderates are left-leaning by nature and the vast majority of them were always going to vote for Obama.

The reason the GOP’s tent is small is that they have one foot in the Progressive camp and (barely) one foot in the Conservative camp. For actual Conservatives, that doesn’t garner enthusiasm. You can’t buy enthusiasm. You can take your ideas to market, but to win, there must be a market for them.

Ronald Reagan won by a landslide after decades of liberals (I include Nixon in this list) occupied the White House. He did it by eloquently marketing true Conservatism with bold colors (not pale pastels).

The GOP doesn’t need a Bill BJ Clinton, they need another Ronald Reagan to turn this thing around. GOOD LUCK!! ; )

xdog November 16, 2012 at 6:42 pm

You forgot to mention the radiance from above falling upon the Conservatives as gentle rain upon the thirsty field.

It doesn’t seem right for gopers to complain about the very candidates they themselves nominated. You guys want a Herman Cain or Rick Santorum, I say go for it.

benevolus November 16, 2012 at 7:21 pm

Demonstrably wrong. There were more conservative candidates than Romney and they lost. Ideological purity doesn’t often win national elections. There are some “less than pure” conservatives out there- not to mention non-conservatives- and you need some of their votes too.
This is the arrogance of extremists from both ends- that if only they could get their message out properly, everyone would buy in. But the reality is that there are other people out there who genuinely believe differently than you, and they are citizens too.
If we had stronger multiple parties this kind of solves itself. Purists of many stripes get their candidates, but in the end those candidates have to compromise to get a majority.
Democracy is all about compromise.

Dave Emanuel November 16, 2012 at 12:34 pm

Of course you support Obamacare. Apparently, you are unaware of the difference between involvement and control.

Chris Huttman November 16, 2012 at 12:39 pm

Well you may think that, but you’re living in a dream world if you don’t think the existing way the world worked was already controlling and forcing outcomes in the healthcare market.

I’d love to hear your alternative that you think a majority of the country would get behind.

kyleinatl November 16, 2012 at 5:19 pm

uuhhh uuhhhhh…TORT REFORM! uhhhhh…SENIOR HSAs!

Sorry, I couldn’t resist.

SallyForth November 16, 2012 at 6:39 pm

Surely you jest, kyle. So-called “tort reform” is just another word for legalized medical malpractice. All it does is shaft the consumer.
And a senior’s health savings account is under their mattress. (unless they are wealthy and have rivers of investment income, in which case healthcare is no problem)

bgsmallz November 16, 2012 at 12:48 pm

“Apparently, you are unaware of the difference between involvement and control.”

Bwhahahaha. I literally spit out my milk on that one.

I don’t want to take sides on this debate, but I do want to point out that any liberal, conservative, or in-between who thinks that the difference between involvement and control under the Constitution as decided by our founding fathers, subsequent legislative acts, and the Supreme Court is easily and clearly ascertained is ignoring 200+ years of legislation and jurisprudence.

View from Brookhaven November 16, 2012 at 12:46 pm

HIX deadline was pushed out another month. Was announced yesterday.

Doubt it changes anything with Deal.

Lea Thrace November 16, 2012 at 1:11 pm

Can someone please tell me why something that was a Republican idea is all of a sudden a bad thing? Werent exchanges one of the main things that Republicans pushed during the healthcare debate? Why is it all of a sudden a taboo? Because Republicans did not propose it?

Dave Emanuel November 16, 2012 at 5:17 pm

It wasn’t a “Republican idea”, it was an idea proposed by a Republican. There’s a big difference. I don’t recall throngs of Republicans proposing similar programs in other states. Secondly, there are exchanges and there are exchanges– they can be of many different forms and limitations can vary dramatically. Governor Deal isn’t objecting to exchanges, he’s objecting to the restrictions and limitations of the mandated exchanges.

There is virtually no form of legislation that’s simple, and health care/insurance is one of the most complex. The comments here deal primarily with rather simple broad concepts and neglect the complexities of implementation. Exchanges are neither inherently good or inherently bad; it’s the manner in which they’re implemented that determines where they fall.

ryanhawk November 16, 2012 at 1:31 pm

This discussion falls under the “stop being the stupid party” label. Republicans need to put forward policies that work to solve real problems. The market for healthcare is not a well functioning competitive market, and the market failures are readily evident and predictable. Americans who aren’t already on government insurance experience these problems with on a regular basis when they do things like have a birthday, get divorced, lose a job, get pregnant, or get sick and find that they no longer have or can not renew their insurance.

Once upon a time Republicans did have an approach to solving these predictable market failures, and it was called Romneycare. Then suddenly we became the “stupid party” and allowed idiots (people who don’t understand the difference between a well functioning competitive market and a lassiez faire free market) to declare that anything other than Free Market healthcare for the young and Government healthcare for the old was an extreme form of communism. And that is where we are today.

I don’t know who has the knowledge and skills to insist on the distinction between free/competitive markets AND win an election, but that is one of many seemingly impossible tasks the GOP faces.

Harry November 16, 2012 at 1:34 pm

More unsolicited advice from a hardly unbiased source. Don’t be so smug about your purported “victory”. Given what’s about to happen it’s probably a blessing the GOP didn’t win the presidency.

ryanhawk November 16, 2012 at 1:45 pm

What’s my bias Harry? I’m a Republican and have been for a very long time. I’m just tired of the stupid.

Harry November 16, 2012 at 1:49 pm

Just leave it up to the GOP base to decide the direction, not a bunch of hacks in DC. I predict in six months the landscape will look totally different.

ryanhawk November 16, 2012 at 1:56 pm

I am part of the base, I’m not in DC, and I’m not a hack. Among our many problems is that we’ve let the hacks have a field day, whether they are in DC or elsewhere. And that’s why we’ve been reduced to being the Party of No — hacks can’t figure a damn thing out whether its healthcare, immigration, education, etc… so they just say no. Time to let smart people like Bobby Jindal uncover their light and let it shine.

Harry November 16, 2012 at 2:04 pm

I trust the base to do the right thing, be it Jindal or somebody else. Let’s see.

kyleinatl November 16, 2012 at 3:06 pm

Oh Harry, you loveable scamp, what’s to do other than be smug about victory…that’s how this game is played ya know?

Go pour yourself a sarsaparilla and relax, it’s Friday.

Three Jack November 16, 2012 at 1:45 pm

If “crazy Rick Scott” is doing it, all the more reason to say no.

Medicaid was/is a voluntary program that was introduced in 1965. If more states would have declined to participate in this ongoing boondoggle, it would have never survived and expanded as happened. Same goes for ObamaRobertsCare, stay out of it now because it will inevitably become a bankrupting ‘entitlement’. Hell, this country can’t afford current so-called entitlements…now we are going to add trillions more?!

Just say no, let the freeloaders all move to California or one of the other states hellbent on self destruction.

Three Jack November 16, 2012 at 1:54 pm

Instead of being forced into public exchanges, Governor Deal could encourage use of private exchanges, good report about them here — http://www.booz.com/media/uploads/BoozCo-Emergence-Private-Health-Insurance-Exchanges.pdf

Dave Emanuel November 16, 2012 at 2:01 pm

To all the oh so enlightened proponents of Obamacare- have a nice day. You have all the answers. I hope you enjoy living with them.

Scott65 November 16, 2012 at 7:31 pm

…better than sticking your head in a hole and saying you can see the sky…which is pretty much your argument…what little there was

John Konop November 16, 2012 at 2:29 pm

Before debating the topic, I think we should understand the facts. This is a very good article about the topic. I do think exchanges if “implemented” correctly could be a cost saving option, especially if it was an self insured model. Once again this is just one small part of the puzzle ie letting seniors and government workers buy drugs through the VA, deregulating healthcare to let nurses do more primary care, put dial a doc phones for non emergency care in hospitals, create incentives for using drug stores over hospitals for non emergency care………..

…………Insurers now charge high premiums for small risk pools, like small businesses, to make sure they can cover whatever claims they might have to pay. This means, for example, if a business has 10 employees and one gets cancer, costing the insurer a lot, premiums for the whole group will be driven up. Health-reform proposals on the table could allow insurers to stay actuarially sound — without setting premium rates on the basis of pre-existing conditions — by forcing every American to get health insurance and allowing small groups and individuals to pool together through a health-insurance exchange (see definition)…………….

Read more: http://www.time.com/time/healthcaredebate#ixzz2CPnj1CU0

Harry November 16, 2012 at 2:59 pm

An uninformed question that maybe somebody can answer…is there a religious exemption?

John Konop November 16, 2012 at 6:26 pm

Harry

If it is done cafateria style it would be a non issue.

atlanta_advocate November 16, 2012 at 3:03 pm

So many intellectually dishonest people. These exchanges were a good idea (conservative foundations and conservative politicians like Newt Gingrich supported them) right up until when Obama proposed them. Then they weren’t anymore. Just like the Patriot Act. Horrible idea when Clinton proposed a form of it in the 1990s after the Oklahoma City bombing. But when Bush proposes it, AND proposes a gigantic new bureaucracy to implement it, Department of Homeland Security, the same people who were trying to eliminate the Departments of Education, Energy, Transportation, Commerce and Education during the 90s got behind it.

So transparent. These exchanges aren’t being opposed on their merits. Instead, people are hoping that if they get implemented, it will somehow keep ObamaCare from being enacted. But that won’t be the case. The people in the states where the exchanges aren’t created will just use the federal exchanges instead. And down the line, when these GOP governors get replaced with Democratic ones – it will happen, as most states aren’t solidly red or blue but the governorships change – they will enact exchanges also.

Oh yeah. Rooting for the economy to collapse to make Obama unpopular … that will help ObamaCare, not hurt it, as there will be more people without jobs and uninsured. So rooting for the economy to collapse – not that it will negatively affect Obama, who is safely in office by the way – is at cross purposes with opposing ObamaCare. The way to oppose ObamaCare is to root for another Bill Clinton type economic boom to get unemployment below 5% again to reduce the people who need the government to get health care, not for a recession that will cause the people who want a job but can’t get one to start thinking that taking money away from George Soros and Rupert Murdoch to pay for surgeries for their kids until they can get back on their feet and buy their own insurance again isn’t such a bad idea.

But hey, since when does thinking straight matter when you are using the “massive resistance” strategy? “It’s a policy that I don’t like, so I am going to oppose it with all I got no matter what.” Let me know when that actually starts to work for you.

And the GOP could have prevented this by coming out with their own health care reform plan. The GOP controlled both houses of Congress from 1994 to 2006. They controlled Congress AND the White House from 2000 to 2006. They had all that time to implement these oh so great alternatives to ObamaCare. They didn’t. Why? Because the insurance companies and Wall Street didn’t want them. That’s why. So they sat on their hands and did nothing. It was only when forced to propose alternatives by ObamaCare that we finally heard about all of these alternatives. Sorry, but if the GOP had ignored their donor base and done health care reform when they had the chance, ObamaCare would have never been implemented because there wouldn’t have been a need. As a matter of fact, Obama might not have been elected – let alone re elected – to begin with.

I don’t like ObamaCare either, but the behavior of the GOP on this issue is disgraceful. The GOP should have started working on real health care reform right after they defeated HillaryCare, because they knew the issue was going to come back. They didn’t, and this time they lost. That’s politics. But it is amazing. When you guys win a political fight, you call it democracy. But when you lose it, you call it thuggery, theft, deception, you name it. ObamaCare got enacted because the Democrats got more votes that you guys did. And that happened because your guys made the horrible decision to pursue interminable nation-building in Iraq and Afghanistan, and let the guys in the financial sector spend an entire decade cooking books, looting pension funds, and paying themselves gigantic bonuses for companies that were going under. If Bush limits the war on terror to, you know, actually fighting terrorists and actually lifts a finger to stop the lawlessness in the financial industry (which Ronald Reagan did by the way … Reagan prosecuted the Gordon Gekkos and broke up the monopolies of his era … funny how a lot of conservatives have forgotten that) then the GOP still controls the White House and Congress right now. But you guys want to blame everybody else but yourselves for your own mistakes. Personal responsibility party … yeah right …

Harry November 16, 2012 at 3:10 pm

The Democrats and RINOs are the ones hell bent on kicking the can right now.

Three Jack November 16, 2012 at 3:07 pm

Cheers to Governor Deal, got this one right!

The Last Democrat in Georgia November 16, 2012 at 3:45 pm

I have a slightly different view on this continuing debate over Obamacare as vastly expanding the powers of government by expanding the IRS by 600 or so agents to enforce the Individual Mandate provisions of the PPACA is a total non-starter with myself and many, if not most, other Americans.

Instead of this bulky massive overreaching expansion of government regulatory power (the Individual Mandate) and entitlements (attempted massive expansion of Medicaid), the Feds should have just taken the money that they already use to subsidize Medicaid and redirect it to subsidize the cost to insurers and hospitals of providing emergency and catastrophic care as a way to bring down overall healthcare costs as the two absolute biggest concerns that every individual has is not necessarily doctor’s office checkups but is GETTING SICK OR HURT and the cost of continuing hospital care for an extended period that can result.

Simply taking away or dramatically reducing the cost of getting sick or hurt and the cost of the continuing hospital care that often results from individuals, insurers and hospitals by using existing financial resources currently alloted for Medicaid could help dramatically bring down healthcare costs for all involved as health insurance would only be needed to cover the cost of checkups and examinations, not the costs of emergency care, catastrophic care and continuing hospital care.

The federal government shouldn’t attempt to pay (through increased taxes on businesses) and regulate and cover all aspects of healthcare as it is bad for the economy and, most importantly, it is bad for Liberty.

The Individual Mandate was an unpopular bad idea when Republicans first proposed it back in the early 1990’s and it is an even more unpopular bad idea now that the Democrats have been stupid enough to take the Republicans’ initially really bad idea and turn it into actual really bad law.

Dave Bearse November 17, 2012 at 9:39 am

How does shifting funding from preventive to emergency care bring down healthcare costs, or improve the general health of the overall population?

Your proposal diverts the funding used to provide healthcare for the poor to support insurance companies, and in some cases, for-profit healthcare delivery. The poor, stripped of preventive healthcare, will then have to rely completely on emergency room health care, the most expensive type.

The proposal’s beneficiaries (other than the insurance companies and elements of the healthcare delivery system), are largely those that can afford emergency care insurance but choose not to purchase it.

The Last Democrat in Georgia November 18, 2012 at 1:44 am

Taking the cost of emergency care, catastrophic care and the continuing hospital stays that result out of the equation by subsidizing it with existing financial resources (directed to Medicaid) instead of hiking taxes on job creating small businesses (which make up over 99% of all employers), dramatically brings down the cost of preventive care (checkups) making it infinitely much more affordable for all (particularly the poor, the uninsured and the UNDERinsured) without expanding the force and power of an already entirely too big federal government such as is currently being done with the hiring of over 600 new IRS agents to enforce the Individual Mandate provision of Obamacare.

The escalating cost of healthcare is not necessarily being driven up by routine doctor’s visits and checkups as much as it most certainly is being driven up by a high and rising number of visits to the emergency room, as you noted, and continuing care (hospital stays, medications, etc. for those who get hurt, sick or terminally ill) by said poor, uninsured and UNDERinsured.

Just simply taking existing financial resources subsidizing the costs of emergency, catastrophic and continuing care through the existing private system, which only needs to be tweaked and enhanced to much better serve the public, NOT scrapped altogether in favor of an attempted government takeover in which one boogie man with its own set of problems on the private side is replaced by another on the public side.

We don’t need a public bureaucracy to replace a private one, we just need to dramatically bring down costs in the current heavily private-based system which is actually setup pretty well to expand to better handle the uninsured and the underinsured if the the costs of emergency, catastrophic and continuing care are lowered or eliminated as those are the costs that insurance companies and healthcare providers absolutely hate the most.

The poor, uninsured and underinsured could much more easily pay for preventive care if the gargantuan costs of emergency care, catastrophic care and continuing care were not part of the health insurance equation.

griftdrift November 16, 2012 at 4:08 pm

Those who fight the last war…

Harry November 16, 2012 at 4:13 pm

And you’re not?

benevolus November 16, 2012 at 4:38 pm

Dang. I had about 50 words written and you said it better in 6.

IndyInjun November 16, 2012 at 6:27 pm

Indeed, Grift did.

Harry November 16, 2012 at 4:48 pm

The last war will be fought when Obamacare puts millions out of work and causes hyperstagflation.

Brian November 16, 2012 at 5:29 pm

It will do much worse! So hats off to Gov Deal. He impressed me today!

IndyInjun November 16, 2012 at 6:30 pm

No problem Harry. Back in September it was reported that the Fed created a new $16 trillion to backstop the banks. Had it been doled out to every household it would have been $133,000 per family.

There are no problems that the electronic printing press cannot overwhelm.

Harry November 16, 2012 at 7:40 pm

The Germans know about it. I think their currency changed 3 times between 1920 and 1945. Of course, that example is a case of fighting the last war.

IndyInjun November 17, 2012 at 8:17 am

I found the Art Cashin account of that era quite shocking. By 1924 a single loaf of bread cost 3 times what the entire money supply of the nation of Germany was 10 years before. That is where we are headed, pretty darned quick.

Scott65 November 16, 2012 at 7:37 pm

Hyperstagflation…ROFL…
Cant have the economy stagnating in a hyper way now…
Thanks Harry…I haven’t laughed that hard in a long time…me thinks you are being a tad sarcastic (at least I hope so)

Harry November 16, 2012 at 7:42 pm

Just remember, the Germany of the 1920s resulted in Germany of the 1930s.

Pinocchio November 17, 2012 at 7:57 am

“Those who fight the last war…” Six words, and so much meaning:

“Fighting the Last War

French military thinking after the war of 1914–18 naturally developed along one line while the Germans as naturally followed just the opposite course. The French general staff understood that the last war had been won with the use of certain strategies and tactics; unfortunately, they assumed that the same or similar tactics and strategies would assure success in any new test of strength with Germany. ”

http://www.historians.org/projects/giroundtable/French/French1.htm

The recent election may have been bought and paid for with POTUS largesse, hackery, voter fraud, etc. as some suggest, or ‘tent-shrink,’ an unpopular candidate, lack of new ideas and divisiveness within the GOP led to a loss.

In other words, the GOP ‘fought the last war,’ during this election cycle; very clever wordsmith, that Grifter…

Polly Sci majors can have at that debate, I care about sound public policy.

Currently, seriously ill US citizens, even with good insurance, can lose everything and find themselves sick and broke(n). That is not the America I know and love.

Resolve the problems, then tell me how smart you are.

Bill Dawers November 16, 2012 at 6:01 pm

Republicans in power in Georgia (and other states) have two options.

They can get in the game and try to improve what they see as a bad law.

Or they can continue to resist all phases of Obamacare, with the likely result that their own citizens will benefit less than those in states that set up their own exchanges and expand Medicaid.

Mary Squires November 16, 2012 at 6:36 pm

Regardless of the arguments of whether or not to set up a state exchange or accept the federal exchange, there is another option we may face: a regional exchange. The regional exchange would be set up by a state for itself and other states within its region. It is submitted for approval to USHHS and then HHS assigns other states in the region to that exchange. The assigned states do not have an option to say no to this exchange. I’m not certain that a regional exchange administered and controlled, even minimally, by Florida or North Carolina is a good choice for Georgia. It helps to have read PPACA and the HHS regulations.

Three Jack November 19, 2012 at 3:52 pm

Mary,

Applying recent GOP logic that the farther away a bureaucracy operates from those it regulates, the better (charter school commission), why not a regional board. It would seem the GOP is all for regional/federal/intergalactic councils so why not with healthcare?

Scott65 November 16, 2012 at 7:38 pm

I just have two words for Nathan Deal

BITE ME

Harry November 16, 2012 at 7:42 pm

Keep it classy.

South Fulton Guy November 17, 2012 at 12:26 am

Red State FRONT PAGE CONTRIBUTOR

Will GOP Governors Save us From Obamacare?

http://www.redstate.com/2012/11/16/will-gop-governors-save-us-from-obamacare/

John Konop November 17, 2012 at 7:50 am

Please help me understand how an exchange is a take over of healthcare? Real facts not spin?

Dave Bearse November 17, 2012 at 10:12 am

In the words of Paul Broun, ostensibly an MD, whose views represent about a third of the GOP base,….

“God’s word is true. I’ve come to understand that. All that stuff I was taught about evolution and embryology and the big bang theory, all that is lies straight from the pit of Hell.” “It’s lies to try to keep me and all the folks who were taught that from understanding that they need a savior.”

Don’t expect anything other than an alternate reality response from those that think evolution, global warming, physics and other accepted science are conspiracies.

You’re dealing folks twice removed from objective reality. Beyond the personal bubble that folks like Broun and supporters build from themselves, there’s the institutional GaGOP bubble. Talk of Price running against Chambliss from the right because—gasp—Chambliss once supported immigration reform, and now he’s suggesting comprimise in resolving the fiscal cliff, is evidence that the recent election results have only strengthened the latter bubble.

Good luck piercing those bubbles, John. And I mean that sincerely for the sake of the nation.

Harry November 17, 2012 at 1:35 pm

Here’s a good comment from poster “popo” on Business Insider:
The program (PPACA) will be bankrupt within the first year because it effectively does nothing to control costs. The illogical notion that you can make something cheaper by having the government pay for it at market rates is mind numbing in its stupidity. Prepare for implosion.

Harry November 17, 2012 at 1:36 pm

Thank a special interest.

seekingtounderstand November 17, 2012 at 9:15 pm

Dear Democrats: Why are you not bragging about the new quotas based on race and not merit for entrance into the any medical training program that receives federal dollars?
Why are you not braggin that in future years costs will be held down by lower pay for health care workers? Boy thats going to help heal people DMV style.
And since the drug corporations pretty much benefit the most from our new health care laws, why are you not acknowleding that you just unleashed one of the greats new ways to corrupt elected and unelected government workers in our recent history? With so much money envolved a vote will be easily bought from our government reps. Care to be on the board of Drug Co. Inc. after you retire?
Yes sir the carpetbaggers on and the south is full of racists.
Oh yes while you rant on about the republicans needing a big tent, this independent voter notices that when a minority even tries to be a leader with an R besides his or her name, you guys try to destroy that person. Thats why I will never support the demorcats who are so destructive as to prevent a person from making his own choices in life. Its like watching you use minorities for human shields with the race card ready to fly as a weapon of getting your agenda thru. Why do you think that works for you. Its horrible way to use people or throw them under the bus.

seekingtounderstand November 17, 2012 at 9:26 pm

Actually let me answer the questions for you…………. because the new health care law was never about healing the sick but about redistribution of wealth and social justice engineering.
At least talk about that honestly. People still do not understand what is going to happen to our healthcare system.

saltycracker November 18, 2012 at 11:31 am

Sitting in a couple recent advance degree and medical graduations I was very impressed with the quality of graduate and the global diversity as brilliant students advantage themselves. The university system is largely funded by Georgia taxpayers and advantaged by the best and brightest of the world tainted to some degree by the acceptance of affirmative action and diversity.

Are our children of all races coming out of a failing undergraduate educational system and our money increasingly used to educate the global smart or for diversity ?
Is our culture driving misplaced educational desires yielding unemployable degrees ?
Are our spoiled children entitled?
Do we have a say in how our money is spent ?

seekingtounderstand November 18, 2012 at 8:22 pm

Thank you for stating the truth that quotas not merit are going to be the way we engineer the new system.

AMB November 17, 2012 at 9:32 pm

More tinfoil needed here !

seekingtounderstand November 17, 2012 at 10:51 pm

can’t answer so demean the opinion.

AMB November 18, 2012 at 10:55 am

No need to answer to the tinfoil crazies. It just gives you importance.
Agenda 21, ACA a takeover of healthcare, the birthers, creationists, Donald Trump-if people would just ignore or better yet denounce the craycray, it would go away.

seekingtounderstand November 18, 2012 at 8:24 pm

AMB refusing to answer……………guess you can not.

saltycracker November 18, 2012 at 11:07 am

Colvin in Fortune nov 12 made excellent points that our congress has the info from bipartisan plans to do what they should on Medicare and tax reform but they have not and will not despite public displeasure with other reps but theirs.

“An index by researchers at Princeton and the Universoty of GEORGIA shows that the 112th Congress is the most polarized going back 130 years.”

“There is no reason to suppose the 113th Congress, arriving in January, will be better than the 112th. But just maybe it’s members will be so panicked by an economy going nowhere and the prospect of more trillion-dollar deficits that they’ll be forced into the unthinkable: cooperation.”

I’d add history shows any fix will be a compromise to the short term not a fundamental change.

IndyInjun November 18, 2012 at 11:46 am

The Reality Party won the election and its guiding ‘philosophy’ is mathematics. Math stands just beneath God and will not be denied or mocked at this point. “Short Term” now means the next toke off the ponzi bong encounters a clogged nose connected to an oxygen-deprived body.

DavidTC November 21, 2012 at 11:51 am

While someone mentioned the fact the GOP controlled the Federal government for years and could have done something about health care, I think people have failed to notice it _still_ controls local government.

And thus, not only could this state make an exchange and have some control over it, but it could _make its own plan and get a waiver from Obamacare_. Duh. Waivers really still exist.

And before anyone says ‘Oh, we’d never get a waiver approved’…you don’t get to say that unless, to some extent, you actually _have a plan_ and start formalizing it. It would be one thing if Republicans got halfway through and, seeing similar waiver proposals rejected from other states, gave up. But no one has even started to come up with a plan. _None_ of the Republican states have started coming up with plans.

The problem is, of course, the GOP literally has no health care reform ideas at all besides buying insurance across state lines (Which we’ve already implemented, to absolutely no effect. Anyone could have, and did, point out that would do nothing, because other insurances companies don’t have _doctors_ here and do not sell insurance where they cannot provide any care. So I’m glad we just wend ahead and _did_ it, showing up stupid it was, thus taking that idiotic ‘solution’ off the table for Republicans here to yammer about.) and tort reform. (And all _that_ is going to do is increase the already astronomical medical malpractice that is going on thanks to budget cuts.)

Seriously. This isn’t two competing ideas on how to solve a problem, this is one party literally giving up on solving it, with no solutions at all. We _pay_ these people to run our various governments.

I have to question WHAT USE IS A POLITICAL PARTY IF IT CANNOT SOLVE MAJOR PROBLEMS?

benevolus November 21, 2012 at 11:59 am

Free trips to Europe?

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