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Conservative Proponent of Insurance Exchange Steps Back

With Governor Dayton’s move to prod the development of an insurance exchange in Minnesota, it’s worth noting that a leading conservative proponent of exchanges has flipped.

Edmund Haislmaier, of The Heritage Foundation, was an early proponent in conservative circles of the idea of insurance “exchanges.” But in light of recent developments at the U.S. Department of Health and Human Services–the overseer of “ObamaCare”–Haislmaier advocates extreme caution, to the point of rejecting federal grants meant to help states design an exchange that complies with ObamaCare.

“The combined effect of these regulations and grant requirements are that a state would have to agree to surrender any last vestiges of meaningful control over how Obamacare is implemented. Thus, a state would now have no more real control over an exchange it set up than over one HHS established.”

Haislmaier had said that states should pursue exchanges as a way to gain some control for themselves in the age of ObamaCare. Now, he tells them to reject federal money, but offers that perhaps they may pursue an exchange without federal money. The hope is that doing so well do some good, and avoid federal strings.

But Michael F. Cannon, of the Cato Institute, argues that even that approach won’t work. He concludes, “Creating any type of Exchange merely lends manpower to ObamaCare’s federal takeover of health care.  States should refuse.”

Cutting out the Middle Man, Health Care Version

While health insurance may be necessary for catastrophic events, it can also get in the way. A Minnesota-based organization is seeking to help doctors and patients connect in a way that avoids the paperwork hassle of insurance companies.

Patient Doctor Direct, based out of Long Lake, is free to patients. (Doctors pay a modest annual fee to be listed in the directory.) It says that many doctors will offer a discount of 20 to 50 percent for cash payments.

It seeks to appeal to several groups of people, including those without insurance and those with insurance policies that carry a large deductible.

When cash is king, the concerns that other people have–government bureaucrats snooping into medical histories, insurance company bureaucrats practicing medicine–go away.

Cash payments aren’t the silver bullet for the problems of health care. (For example, it does nothing to change certificate of need regulations, prevent lawsuit abuse.) But cutting out the middleman has benefits.

For more on Patient Doctor Direct, see this recent article from the Dakota County Tribune.

Should Minnesota drop out of Medicaid?

One of the possible consequences of ObamaCare is that states might come out ahead financially  by dropping out of Medicaid–and without reducing the number of people receiving taxpayer assistance.

First, here’s a quick review of Medicaid. No state has to have a Medicaid program, but all of them do. That’s because if they do, they get matching funds from the U.S. Government. Poor states such as Kentucky get more, rich states such as Minnesota get less, but in any case, once a state sets up a Medicaid program, the U.S. Government calls the shots. (It can and does grant “waivers,” which are exceptions to its rules, but states must play the “mother May I?” game.)

Unlike Medicare, a federal program limited (for the most part) to people who are 65 years old and older, Medicaid is (allegedly) limited to only to the poor. I saw allegedly because states have over time let more and more non-poor people receive health care through Medicaid.

ObamaCare calls for states to set up artificial markets for insurance, called exchanges, and then for the U.S. Government to give people–mostly the non-poor–subsidies with which they can purchase health insurance policies sold through the exchange.

According to an analysis conducted by The Heritage Foundation, states as a whole could do well financially if they simply stop participating in Medicaid.

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