Many states are wisely signaling that they aren’t interested in doing the Obama administration’s bidding on Obamacare. As a result, many if not most of Obamacare’s insurance exchanges — the heart of the beast — will have to be set up and run by the Obama administration at the federal level.
States are not required to set up Obamacare exchanges, but it seems to have surprised observers that many are choosing not to. Politico reports that, with only 17 states so far having said they will set up the exchanges, the “Department of Health and Human Services’s role in bringing the law to life is going to be a lot bigger than originally thought.” More than a third of all states have already said they won’t set up the Obamacare exchanges. Among others, Republican governors Scott Walker, John Kasich, Sam Brownback, Rick Perry, Bobby Jindal, Nikki Haley, Nathan Deal, Paul LePage, Robert Bentley, Mary Fallin, and Sean Parnell have said they’ll refuse to set up the exchanges in their states.
In Missouri, voters took matters into their own hands, approving a ballot measure to vest authority over the decision in the Republican-led state legislature, rather than leaving it up to the Democratic governor. Missouri will not be establishing an exchange. Utah governor Gary Herbert, meanwhile, has opted for a sort of mild civil disobedience, saying that his state will continue to pursue “our version of an exchange based on defined contribution, consumer choice, and free markets” — a type of exchange that is rather plainly banned by Obamacare.
States’ refusal to be complicit in this crucial aspect of Obamacare should shine a spotlight on the development of the federal exchanges — and what it illuminates won’t be pretty.
The Obama administration’s congressional allies botched the drafting of this aspect of the health care overhaul, as the plain language of Obamacare doesn’t empower federal exchanges to distribute taxpayer-funded subsidies to individuals; it empowers only state-based exchanges to distribute the subsidies. (The administration pretends otherwise.) Moreover, the Department of Health and Human Services (HHS) is lagging behind in developing the federal exchanges.
It gets worse. HHS has contracted with a subsidiary of a private health care company to help build and police the very exchanges in which that company will be competing for business. The person who ran the government entity that awarded that contract has since accepted a position with a different subsidiary of that same company. An insurance industry insider (speaking on the condition of anonymity) says that HHS, in an attempt to hide this unseemly contract from public view until after the election, encouraged the company to hide the transaction from the Securities and Exchange Commission.
According to my source (the basis for most of this account), in January, HHS awarded Quality Software Services, Inc. (QSSI) what the Hill describes as “a large contract to build a federal data services hub to help run the complex federal health insurance exchange.” At that time, the director of Obamacare’s newly established Center for Consumer Information and Insurance Oversight (CCIIO) — which the Hill describes as “the office tasked with crafting rules for the national exchange” — was Steve Larsen. Larsen had been the insurance commissioner for Maryland when Obama’s HHS secretary, Kathleen Sebelius, was the insurance commissioner for Kansas, and the two are reportedly close. The CCIIO awarded the Obamacare exchange contract to QSSI while Larsen was the CCIIO’s director, and he played a central role in planning the construction of the exchanges — although it’s not known whether he made the decision to award the contract to QSSI or not.
Under the contract that it signed with HHS, QSSI’s power would be substantial — as QSSI would shape, run, and affect companies’ ability to compete to sell insurance through Obamacare’s federal exchanges. The Hill writes, “A draft statement of work for the contract awarded to QSSI states the contractor should provide services necessary to acquire, certify and decertify health plans offered on a federal exchange.” Moreover, “It stipulates the contractor should monitor agreements with health plans, ensure compliance with federal standards and” — somewhat strikingly — “take corrective action when necessary.”
QSSI, apparently realizing what a valuable asset it had in the contract, started shopping itself around. Meanwhile, Larsen left the CCIIO and took a highly paid position with Optum, a subsidiary of UnitedHealth Group, in June. Sometime this summer, UnitedHealth Group bought QSSI.
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