The decision of whether the state of the federal government gets to decide about health care reform is something that is leading to heated deliberations. It is currently the key dispute between the senate and the house as they mend their health care bills.
The house wants to establish a national exchange which would create a uniform program for all customers. They feel that it will help protect the people. But the states want to retain their clout by creating and running their own exchange. Their argument is that states have more experience dealing with local insurance needs and also with local communities.
The backers of the national exchange feel that the centralized system will be more effective for a number of reasons. For one, the system will either fail or not fail. There is no saying how many will be successful if you leave it in the hands of 50 states decide what to do about their health care system. This was the opinion of a research professor at Georgetown University.
And on the other side, backers of the state system say that consumers would be able to handle the system better when they are made to deal with the state, as it would be more accessible than a federal system. For instance, commissioners are saying that weak federal oversight of the Medicare advantage program has left consumers susceptible to widespread marketing abuses.
There are a lot of political implications to this development. The liberals feel that the government insurance plan or the public option will not find mention in the final package. Hence they want the federal government to have as much power as possible over the consumers.
A bill called the house health overhaul bill will establish a new organization called the health choices administration. This administration will oversee the exchange and will also regulate the insurers who will participate in it. But the house bill will not entirely eliminate state responsibility. The state will retain certain duties such as ensuring that the health insurance satisfies certain coverage standards, they will also follow appeals processes on insurance denials, and will also take action against insurers who break the law. The basic gist of the federal argument is that too few states have the money and the power to handle such a bill at the moment given the financial crisis. In such cases, the federal government will ensure that it fills the gap where the state is not in a position to provide sufficient services.
But in any case the problem will arise when decisions will need to be made as to how and when the federal government will interfere in state affairs, and also up to what extent the state can continue handling its issues.
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