The following is the second post in a two-part series by staff member Melissa Perry about the ongoing pressure from the Arkansas Insurance Department to establish a government-run health insurance exchange in our state.

We have got to get through the lie that by accepting federal money, Arkansas can set up its own “tailor-made” healthcare system. Are you kidding me? Below are 4 major reasons that Arkansans must stand up to the bullies controlling state government and continue to reject Obamacare in the State of Arkansas.

1. State Momentum Impacts Federal Momentum. We are against states setting up State Health Exchanges of the kind that are mandated by Obamacare. We are against accepting federal money to set up Health Exchanges in Arkansas because by accepting federal money, we are also accepting the federal strings attached. The reality is, if enough states reject Obamacare, I believe it will fail. I believe if states refuse to buy into this, the lack of momentum will influence the decision of the United States Supreme Court on this issue. However, if state after state goes ahead and starts implementing Obamacare, as Beebe and Bradford are pushing Arkansas to do, then the Supreme Court is going to have a hard time overturning it. You think I am crazy? According to some legislators that spoke out at the Summit on Tuesday, the Florida Supreme Court has already said this. State momentum (or lack of) will greatly influence federal momentum. If it is clear that the states are not buying in, it will flop. I am oversimplifying, but oversimplification is sometimes helpful.

2. The Constitutionality of Obamacare is Still in Question. Those who are for Obamacare and Health Exchanges want you to believe that the Affordable Care Act (PPACA) is a foregone conclusion. They want you to buy in to the fact that this is federal law and there is nothing we can do about it. Because if you think there is nothing you can do about it, you won’t try. You will accept it. You will start trying to figure out how to make Obamacare work instead of trying to find a way to stop it. The truth is, the issue of the constitutionality of PPACA is still in the courts. Arkansas does not have to buy in. Let’s send a message that we cannot be bought.

3. The Lie of Local Control. Even if Arkansas sets up a so-called “State Exchange”, we will still be under the thumb of the Federal Government. It is unlikely that the U.S. Dept of Health and Human Services (HHS) will allow states that accept federal grants to then ignore federal mandates. The Obama Exchange system will require insurers to meet “minimum essential coverage” requirements. Who do you think gets to decide what is “essential”. Arkansas? Arkansas voters? No way. The U.S. Dept of Health and Human Services will get to decide what is “essential”. Maybe HHS decides abortion is essential. Maybe HHS decides long-term care for seniors isn’t. It is an absolute lie that Arkansas will have any control over substantive issues if we accept federal money to create a “State Exchange”.

4. The Illusion of Local Control. One of the panelists today said that Arkansas would get control over the things it does best i.e., manage insurance companies, work with consumers (a.k.a. “consumer call centers”), and manage a “Navigator Program”. When Arkansans think of “local control” over issues of healthcare, I don’t believe they are worried about who runs consumer call centers. In addition, we already have a “Navigator Program” in this state that is run by Independent Insurance Agents (who, as an aside, could lose their jobs as a result of Obamacare). This has nothing to do with “local control” of issues that really matter to Arkansans such as what items of healthcare are “essential”, which insurance companies get to participate in the Exchanges, what happens to the ARKids health insurance program in Arkansas, when do insurance companies get to raise their rates, what gets done with your personally identifiable health information, and the list goes on and on. Make. No. Mistake. The choice is NOT between a state-run exchange or a federal-run exchange. The choice is whether we, the people of Arkansas, allow Obamacare to be forced on our citizens under the veil that it empowers consumers or gives more people access to quality healthcare.

The bottom line of every single debate about Obamacare is that it is designed to give the federal government control of your healthcare, your grandparents’ healthcare, and your grandchildrens’ healthcare. And, at the end of the day, whoever controls your healthcare, is aiming to control you. This is bigger than winning a political debate, and in fact, has nothing to do with it. This is about allowing the federal government to control us. This is about shutting our eyes, holding out our hands and letting the federal government lead us around while tickling our ears and telling us it’s all about “us”. Don’t do it Arkansas. Don’t do it Arkansas Legislature. Spread the word.

1 Comment

  1. Ethan

    Once again, I enamored with the amount of speculation espoused on your blog and feel compelled to respond to the fantastical notions wildly thrown about on this page.

    First, as a matter of policy it may be quite correct anecdotally that momentum on a state level might influence what happens federally, but the potential effect that such momentum may have is not to halt what is required by federal law. The only potential effect might be the pushing back of deadlines or softening of base requirements. As to your flawed legal conclusions (which are based on similarly flawed legal conclusions of non-attorney legislators), the Supreme Court of the land (as opposed to the one of many district courts in Florida (there is no federal Supreme Court in Florida), does not look to dicta of lower courts to make its decisions. In fact, the Supreme Court rarely looks to the legal reasoning of district courts (and for that matter Circuit Courts of Appeal) when it makes decisions; instead it relies on its own precedent to render opinions. So, no, I don’t think you are crazy, just misinformed.

    You are correct on your point regarding the acceptance of federal money being conditioned on following basic regulations regarding exchanges. However, those conditions precedent only become effective when implementation money is requested. No implementation funding has been requested at this time, and the planning funding requested has no similar (and as you have casted the, shadowy and potentially evil) strings.

    Yes, the constitutionality of the Act is in question and has been for some time. The majority of legal pundits believe that the Supreme Court will not even get to the merits of whether the individual mandate is, in fact, constitutional. Indeed, most contend (and it is also evidenced in the number of district courts that threw out challenges to the law on jurisdictional issues) that the Court will dismiss the challenges based on a ripeness issue.

    You are indeed correct that HHS will determine what is in the essential benefits package. The Institute of Medicine has recommended that the package be based on what is generally seen in the small group insurance market: here, affordability is an issue. However, the IOM also recommended that states with state-based exchanges have the authority to tailor the essential benefits package to meet the needs of the state. Without a state-based exchange, Arkansas will not have that option.

    As I mentioned in my response to Part 1 on this topic, with state control Arkansas maintains control over negotiations with insurance carriers about costs, quality, provider network adequacy, etc. It’s not just about navigators (which, by the way, if Arkansas maintains control of the exchange, brokers/agents can be navigators). Additionally, a state-based exchange allows for the state to maintain control over eligibility and enrollment for Medicaid; with a federal exchange that is ceded to the feds.

    So, yes, we are still talking about this because there is misguided rhetoric floating about. Oh, and it’s the law.

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