NC's health care exchange will be state-federal partnership

Federal government and state to share responsibility

lbonner@newsobserver.comNovember 15, 2012 

— The federal government and the state will share the responsibility for setting up a health care exchange in North Carolina, Gov. Bev Perdue announced Thursday.

Republican leaders had mixed responses to the decision, with the Senate leader saying the lame-duck governor should not have acted.

The exchanges, online health insurance shopping centers for individuals and small businesses, are required under the new federal health insurance law but many states didn’t prepare for the exchanges, hoping for a repeal of the law. Last year, a consultant estimated that about 700,000 state residents would find health insurance coverage through the exchange in 2014. The state has three options for a health care exchange: have the federal government set it up, have a state-run exchange, or a hybrid state-federal exchange.

High drama surrounds this piece of the health care law because deadlines are closing in on states who had not declared their choices.

Perdue said she would have preferred a state-operated exchange, but chose the intermediate course so that Gov.-elect Pat McCrory and the legislature can make a future choice to go to a fully state-run or to a federally run exchange.

“It will be an important choice and one the incoming administration is very aware of,” Perdue said.

McCrory acknowledged that Perdue’s decision keeps the state’s options open, but he did not say what kind of exchange he would prefer.

“Governor Perdue’s decision leaves flexibility for North Carolina in the future when it comes to the delivery of health care,” McCrory said in a statement. “I will be discussing this with more governors today, and will continue those discussions in the coming weeks to ensure the best results for North Carolina.” McCrory is at a Republican Governors Association annual meeting in Las Vegas.

Senate leader Phil Berger blasted Perdue for making a decision on an important issue that he said should have been left until McCrory takes office.

“Let’s set the record straight – it is not necessary or appropriate for Gov. Perdue to prematurely declare her intent to establish a state-federal partnership exchange,” the Eden Republican said in a statement. “The initial deadline for the state to make this declaration is February 15, 2013 – three months from today. The voters elected a new legislature and governor last week and policy decisions of this magnitude should be left to them.”

Berger said he did not object to the state applying for federal grants to pay the state’s costs “as long as it does not frivolously spend the tax dollars until the new leaders determine the next steps.”

The federal government had a series of deadlines for states declaring what kind of plans they want, submitting plans and applying for grants.

“Declaration letters” are due Friday for states that intend to run their own exchanges. They’re due Feb. 15 for the state-federal exchange. Perdue said she is submitting North Carolina’s declaration letter Friday.

Late Thursday, Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, extended the declaration deadline until Dec. 14.

Thursday was the deadline for states to apply for federal grants. The state Department of Insurance submitted an application for a $73.5 million federal grant to pay for state-based consumer assistance, reviews of health plans’ qualifications and business practices, and technology.

Some Republican governors, opposed to the health insurance law, have decided to let the federal government run exchanges in their states.

Other states delayed their decisions awaiting the outcome of the U.S. Supreme Court decision on the law, and then the presidential election. Republican presidential candidate Mitt Romney promised to repeal the law. The conservative group Americans for Prosperity has been pressuring Republican governors to not set up state-run exchanges.

Dallas Woodhouse, Americans for Prosperity state director, said in a statement it would work to undo the exchange after Perdue leaves office.

Earlier this week, the Associated Press reported that some Republican governors, including one of the exchange’s most vocal opponents, Rick Scott of Florida, are shifting toward acceptance. Scott told the news service he wants to negotiate with the federal government to help the nearly 4 million uninsured people in his state, saying “if I can get to ‘yes,’ I want to get to ‘yes.’ ”

Perdue’s options were limited. Proposed legislation last session that would have allowed for a state-run exchange stalled in the state Senate after passing the House. A consultant’s report from August said the state didn’t have enough time to set up its own exchange and get it running on time.

Without a law permitting the state-run exchange, the state-and-federal exchange was the next best option, said state Insurance Commissioner Wayne Goodwin, a Democrat. But the state should move to run its own exchange, he said, so state residents won’t have to dial out-of-state call centers for help and to keep the federal government from controlling a large segment of the state insurance market.

“We should not be handing the keys to state sovereignty, especially over health insurance regulations, to the federal government when North Carolinians know what’s best for North Carolinians,” he said.

Bonner: 919-829-4821

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