Facing political pressure over his broken promise that people could keep their health insurance plans under ObamaCare, President Obama last week announced a fix to make good on that vow.
Except states have the final say on whether they will accept the fix, which would allow, but not require, insurers to extend policies that would otherwise be nixed by the health care law. And in the early going, Obama is finding that his most willing partners are largely those who threw fits about ObamaCare's earlier provisions: Republican governors.
Thirteen states have so far said they will let insurers extend canceled plans; nine of those states have Republican governors. Conversely, of the eight states to decline the federal fix to date, seven have Democratic governors.
That GOP-led states would be more willing to latch on to an ObamaCare tweak that blunts the law's impact is not too surprising. But that partisan motivation only partly explains the split. In addition, those states, by thumbing their noses at other aspects of the health care law, made it harder for their residents to obtain health insurance, and they may now need more help to keep people covered.
Of the aforementioned nine GOP-led states, every single one declined to establish their own exchange marketplaces, and only one, Ohio, has said it will accept the federal expansion of Medicaid under ObamaCare. Combined, those two refusals effectively kept millions of otherwise eligible Medicaid enrollees on the sidelines and, given Healthcare.gov's hiccups, made it that much harder for the uninsured — including people being booted from their old plans — to find and obtain new coverage.
Remember, the state-run exchanges have been the biggest success story in the early going, accounting for three-quarters of all October ObamaCare enrollments. And despite the dismal cumulative enrollment number nationwide, several states with their own marketplaces, like California, are already on pace to hit their enrollment targets for 2014.
Further underscoring that point, deep blue Oregon and Hawaii, both of which expanded Medicaid and launched their own exchange marketplaces, are also in the "we'll extend old plans" camp. Oregon's marketplace has been a total disaster, enrolling exactly zero people in October, and Hawaii's has hardly fared better, meaning they, too, could use all the federal help they can get now.
The seven Dem-led states sitting out the fix, meanwhile, all built their own marketplaces, and they all accepted the Medicaid expansion.
That, in part, could explain why Texas — which enrolled only 3,000 people in October — will allow consumers to keep old health plans, while New York — which enrolled 16,400 and covered thousands more through Medicaid— will not. New York Gov. Andrew Cuomo essentially said as much in defending his decision not to participate in Obama's plan.
"If it is causing a problem for someone we will certainly look at it," he said, adding, however, that, "our program has actually been working well."
There's another political angle, too: The proposed fix could wind up hampering ObamaCare's effectiveness.
The exchange marketplace works, in part, by creating a new pool of consumers for insurance companies to compete for, thus driving down costs. If not enough healthy people participate, it could cause premiums to spike and undercut the entire system.
Washington was the first state to say it would not allow insurers to extend old policies, with the state's head insurance official, Mike Kreidler, saying he had "serious concerns" about "its potential impact on the overall stability of our health insurance market." Minnesota's top health executive likewise said the Obama plan would cause "major market disruptions" and possibly drive up premiums.
Insurers, too, aren't so certain the plan, given ObamaCare's complexity, will have its intended functionality without having unintended negative consequences. The plan is a "logistical nightmare," one insurance industry consultant told CBS, that "is likely to lead to serious customer service problems."
So in short, Obama's plan is a welcome political salve for states where enrollment is lagging — and, in the case of GOP-led states, where enrollment is lagging specifically because of their reluctance to embrace ObamaCare's other provisions.