Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama’s Health and Human Services Department can’t simply take a system off the shelf as a one-size-fits all failsafe.
"You can't simply deploy one federal exchange across the board," said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.
"Each state is different — their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state."
Every state must have an exchange by Jan. 1, 2014, meaning HHS doesn’t have a lot of time to do a massive amount of work. The department could quickly run through a $1 billion fund designated for implementing the exchanges.
Experts have predicted that the department will soon have to tap budgets from its other programs to cover exchange costs. Other have said it might charge fees on the insurance purchased in its exchanges once they are launched.
So yes, Republican governors (and even a couple Democrats, looking at you, Missouri's Jay Nixon) are trying to do everything they can to break the system. The same people saying "Give us control of Medicaid because states can do things more efficiently" are trying to make state insurance exchanges as inefficient as possible in order to harm as many people as possible, believing they will then rise up and demand an end to Obamacare.
Sure worked for Mitt Romney, huh guys. And let's not forget there are actual lives at stake here, too. It doesn't seem to bother these governors much, either...and with blue states where federal taxpayers foot the bill like California, New York, and Illinois, it's interesting to note that it's the poorer red states who are expecting federal handouts here to build their exchanges for them.
Which side has a problem with "takers" now?