Op-Ed: Maine Legislature Wise in Halting Health Exchange

A protester holds a sign at a rally opposing Obamacare in Portland in 2009

The recently adjourned Maine Legislature made a great decision this session and wisely delayed setting up a health insurance exchange until the Supreme Court rules on the constitutional challenges to the federal health law.  A decision is expected in June.

To date, the federal government has given over a billion dollars to entice states—many of them challenging the law—to establish health exchanges that will facilitate the federal takeover of health insurance regulation.  Even though a state-created exchange is not required by the law, 17 states have moved forward with implementation.

The majority of states, like Maine, are still either studying options, have rejected exchanges outright, or are waiting to see if the overall health law is constitutional.

For officials in these states, the risks of setting up a health exchange at this time outweigh the benefits.

While the current narrative from proponents of the health law is that states must aid in the federal takeover in order to preserve flexibility, others see little flexibility in the 2,700 page and law and accompanying HHS regulations.  Instead, they recognize that every aspect and decision, from operation to implementation, must be approved by federal bureaucrats in Washington.

At the same time, it remains unclear whether the federal government has the time and resources to implement exchanges without state help. The law technically does not provide Washington with any more money to set up a federal exchange in states that haven’t volunteered to implement the law—federal officials have implicitly admitted this through budget requests for additional funds to set up federal exchanges

Additionally, even though exchange provisions under the law were intended to serve as the mechanism to distribute new subsidies, the law allows for those subsidies to flow through state-created exchanges, not federal exchanges. Even if these serious issues are resolved, it is still unlikely that the federal government could get exchanges up and running by their own 2014 deadline.

Meanwhile, questions remain as to just how much an exchange would cost the state of Maine and who exactly will pay for it. The federal government provides grants to states to get their exchanges up and running, but that money will run out in 2015. After that, states that volunteered to set up exchanges for the federal government will assume the burden of operational costs. In states that have passed exchange legislation, lawmakers are considering new taxes to help pay for operation.

With the uncertainty surrounding the health law, serious questions as to its flexibility, and new costs to the state, the Maine Legislature recognized that now is not the time to risk taxpayer dollars, state or federal—especially by voluntarily implementing the same law it, and 25 other states, argued was unconstitutional just last month in the U.S. Supreme Court.

Christie Herrera is director of the Health and Human Services Task Force at the American Legislative Exchange Council, a nonpartisan, nationwide association of state lawmakers.


  1. The federal government has given over a billion dollars to “entice” states to establish “health exchanges”… seems a lot of money goes into insurance. We don’t need insurance; we need access to health care. Our government wants to support health insurance businesses – and maintain a workforce to pay taxes. Seems if government wants a productive and healthy workforce it will need to rethink its strategy, and get big insurance businesses’ hands out of the pockets.

  2. You have focused on the precise problem!  The ‘Affordable Health Care Act’ is not about Health Care.  It is about Insurance.  

    Having insurance does not mean you will be any healthier:  it is to help with the payments.  Some insurance policies are less expensive than others.  Being able to insure yourself only for those things you might need above what you can plan to need is important.  

    The recent hullabaloo about all companies providing free birth control including aborticants is a case in point.  It was not birth control methods that were being discussed:  it was who would pay for them.  No one was denying access.

    Having the coverage does not mean you will get the care.  Not having the coverage does not mean you will not.  Continuing to confuse the two things, insurance and services, muddies the waters.  Probably on purpose.

  3. This may sound snarky or sarcastic, but that isn’t my tone; since when should the government have a ‘strategy’ of supporting health care businesses or attempting to create a productive and healthy workforce?

    It’s shocking to me how easily we can take such a concept for granted, how easily it enters our conversation.

    To my way of thinking, the solution to many of our current problems would be solved by radically limiting the role of our government.  We the people should be solving our own problems in the free marketplace.  It is simply and utterly beyond the role of government to maintain a workforce, that seems like such a socialistic concept to me.

    I believe there is a direct correlation between government spending on health care and the  ‘problems’ we are now trying to solve (we went from under 1% of GDP before 1965 to around 15% now).  It’s not surprising to me to see costs spiral out of control when the government dumps billions of dollars into an industry, completely destroying the normal ebbs and flows of costs via supply and demand.

  4. No, I don’t take your comment as snarky or sarcastic. What I was hear you saying is that government needs to be less involved in our lives and that it’s taking more money from the taxpayers to “govern” as the years go by. Yes, I agree that is true. What I’m saying is the government wants to keep raising our taxes (on all levels, including local and State – in addition to products we buy, fees we may pay for various licenses, registrations). Mandating people buy health insurance is another form of taxation; ultimately this is money lining pockets of insurance businesses and their highly-paid executives. Spending billions of dollars to entice States to get onboard with this plan is a phenomenal waste of money. In the end this new “taxation” does little to create meaningful access to health care. Government wants a productive workforce in order to get its revenue – taxes. The bottom line is government wants both sides and the middle; how much more is it going to squeeze from taxpayers and should we expect little in return?

  5. The Maine legislature acted not wisely, but foolishly.

    About the only legitimate objection to the Affordable Care Act’s exchanges is the possibility of “adverse selection” (i.e. – that subscribers will sign up only if and when they need care). This, of course is why the individual mandate is important: it assures the broadest pool of insureds, thereby reducing premium costs for all.

    It doesn’t limit choice. It creates more choice.

    Under the Act, we can purchase insurance from anyone we like. We can keep our own doctors and coverages if we like. The choice is ours.

    The Affordable Care Act isn’t a government takeover; in fact, its the
    opposite. It forces private insurance companies to engage in practices
    and pricing that benefit consumers of health services more than
    shareholders. It does so by encouraging competition in the marketplace.

    Today, the people with no choice are the ones who can’t afford health insurance no matter who’s offering it and their numbers are growing every day – with every rate hike and every lost job in Maine.

    Far from being non-partisan, Ms. Herrera speaks directly on behalf of the most influential legislative advocacy organization in the country: A.L.E.C. Her opinions are not only suspect they are bought and paid for by the health insurance industry.

  6. Explain to me why a ‘health insurance exchange’ is different than repealing mandates and enabling health insurance companies to compete with a la carte policy pricing? Why can’t mainers just go on the WEB and shop for the policy that best suits their needs?  What makes it so expensive to run? and why isn’t this money going into direct care or high risk pools?   

    I really don’t understand this; and I thought that this was a modification of Olympia’s original proposal to set up health insurance exchanges.

  7. So the government has to force people who don’t need insurance to buy it, even if they can cover their health care needs out of their savings or earnings, i.e. self-pay; or special insurance like workman’s comp, sports, and auto? 

    If people can’t afford health insurance; they pay for their health care from savings or even a health care loan program. If they are poor then they are eligible for MEDICAID/Mainecare or other specialized programs.

    Many people have healthy lifestyles, avoid risks, and have superior genes.  Why should their health ‘wealth’ be confiscated to pay for the care of people whose defects, diseases, and handicaps can cost millions to deal with, especially with the un-ending flow of illegal migrants and the lack of screening for people with health and mental defects who were for hundreds of years sent back to their country of origin. This draconian government action is totalitarian and hardly affordable…why pay for something you don’t and won’t need for years? Cheaper to set up ‘free clinics’ or health care vouchers or employer based options where paying into the insurance plan is a condition of employment. 

  8. The “Snowe Compromise” proposed by the so-called “Gang of Six” was actually quite thoughtful. It recognized that the possibility of a Public Option as a necessity if private insurers didn’t respond. What it lacked was an understanding that assured coverages and the need for a comprehensive pool of resources were critical to an effective national policy.

    Personally, I thought her “trigger” for a public option was brilliant.

    So much for thoughtful compromises.

  9. Hi!

    What is the delegation of authority for the “general” government to be involved in health care to begin with according to the Constitution of the United States?

    The answer is: None.

    There is NO mention of health care in the constitution.

    The “general” government derives its power from the Constitution of the United States and cannot lawfully over ride the said constitution.

    Furthermore, we have a system in these united States called health care but it is actually “sick” care. There is very little, if any, talk about preventative care in this sick care system.

    Most people would need very little insurance coverage (lower premiums?) if the system was based on preventative care.

  10. If ObamaCare isn’t good enough for Congress to enroll in it, why should it be good enough for me?

  11. I’m backing up a step further and asking ‘why do we look to government to solve problems’ when the only track record they have is to destroy the free market in every instance where they intervene.

    I wish I could share your belief that the government is actually concerned about our health (even for something as cynical as keeping us alive to collect taxes from us) but I don’t believe it.  This boondoggle has been all about the destruction of private insurance in order to clear the way for a single payer, government run health care system.  

    Does the government even collect taxes from the people who have no health insurance?  The bottom 50% of income earners pay nothing in taxes, so I don’t think Big Health Care is all about keeping people healthy so they can keep paying taxes.

    We need to stop (and by extension the people who purport to represent us in Congress) looking to government, especially the Federal government, whenever we need to solve a problem.  There is nothing magical about health care that precludes it from being regulated by the  same supply and demand pressures that any other commerce enjoys; unless you consider the artificial price pressure that is injected by our government.

    Here is the solution to the health care ‘crisis’ :(remember you heard it here first)

    1.  Severely curtail government spending on health care-limit it to 5% gdp.  This would drastically lower prices by decreasing the artificial upward pressure currently in place (what incentive does a company have to lower prices when they are guaranteed payment no matter what their price).

    2.  Allow people to buy their health care from anywhere, no more of these incestuous state  cabals.

    3.  Offer tax incentives to businesses who provide health care.

  12. Well, I suppose if we should not look at a government to take our tax money to pay for a government run health care system (instead of a privatized for-profit system that imposes no less than a 20% overhead, as things go), then they should be using that money they get from us to sponsor war and bailouts instead! Perhaps diverting those enormous Homelame Stupidity funds into something actually PROVIDING something of TANGIBLE VALUE to the general public is a horrible idea?

    And the “bottom 50%” actually DO pay taxes: sales tax, excise tax, FAR MORE proportionately of their miserable excuse of income goes into simply SUSTAINING their existence, and paying the INTEREST upon money they are forced to borrow just to live! Which is a tax, is it not? 

    Governments destroy free markets to ensure profitability to their megascale corporate cronies: no-bid contracts, bailouts at public expense, breaking up AT&T to give ninety million middlemen an excuse to slam the client… the notion of “free enterprise” is simply an illusion derived from Wall Street propaganda. The profits are privatized. The risks are socialized.  That’s business as usual. I suppose “free enterprise” and “outsourcing” are a match made in Heaven?

    Let me refute your points in a friendly fashion:1) See above. Government spends your future on bailouts, war, and other private-sector profits. The general public sees nothing in return but more debt. So if they actually get SOMETHING back, is this bad? So waitaminnit: “Government” spending? Who pays for it again? The Government? No, WE do. Since when has everyone been blindsided into accepting the Government as a separate entity from The People? I know it’s the case, but really! Your tax money goes to pay the Federal Reserve Bank for interest on fiat currency that could have been minted and issued at NO INTEREST COST TO THE TAXPAYER. Then these wanks would have had no incentive to throw it at an endless succession of false-flag ops. See the pattern?2) Wherein this seems like sound policy at a moment’s notice, and you are absolutely correct about incestuous state cabals, how will insurance become more affordable WITHOUT governmental regulation? Do you actually think if given carte blanche to charge what they assume the market will bear in the face of practically mandatory insurance, these insurance companies will actually have ANY incentive to compete for your dollar? I propose EVERY American should have the SAME policy the President has. The problem is, and always will be a for-profit insurance and pharma system. These current conditions exist… surprise… because senators are bought by insurance, pharma, medical, and just about every other lobby but We the People. So at the end of the day, who foots the bill for Service Disconnected Per Request of Our Sponsors? WE do. Deny it at your own risk.3) Why not? We offer tax incentives to very profitable corporations. And religious organizations that are actually PACS in sheep’s clothing! So why should we not offer incentives to shift the responsibility of health care from any government entity to some Ma and Pa small business that cannot compete as it is in a market oversaturated with junk, derivatives, paper stocks, and mired by regulations rewarding their huge competitors at public expense? Well, perhaps because those incentives will not do very much NOT to impose a backdoor levy upon their bottom line. The problem with that idea, whereas it seems sound at face value, is, as with the rest of your solutions, this does not address the problem that costs are spiralling way out of control due to fraud, mismanagement, inefficiency, etc.  Sure, eventually the problem will correct itself. It will ALL go belly-up when only a small fraction of the public retains enough solvency to buy insurance in the first place. And, not to harp on an obvious complication, but your solution assumes jobs are being created, and inflation is not hamstringing everyone’s budget already. Since anyone with any knowledge can clearly deduce this is far from being the actual situation, and that anyone blowing smoke about economic recovery is doing so with eyes wide shut, these solutions, while they would work well in a world bereft of top-down betrayal of public trust, clearly fall way outside of contemporary reality. I applaud your idealism. In a world of trustworthy business, this all MIGHT work to a point. However, here we are.Do you REALLY think a “free market” exists within the same context as placing the public in debt for corporate fraud? Sure, “We need to stop looking to Government to…”But what again are we paying them this percentage of our labor for in the first place? Should we continue to pay them more and more for less and less, as we are currently doing? All we’re really doing now is glad-handing the medical and insurance industries our blood and sweat for worsening care.All any policy so far enacted does is reward monolithic fraud and theft at public expense, as intended. It takes your dollar, and hands more of it to “free enterprise” already.I suspect people might be in for a pleasant surprise if they saw their government working for THEIR BEHALF for a change, instead of fostering indolence, stupidity, and a permanent golfing vacation in what passes for our Capitols today.Posted by Warren Hugh Bayloutz who is no relation whatsoever to the poor bloke on the account…Just a thought…

  13. Thanks for your your articulate and thoughtful reply. 

     I appreciate civil discourse, if more people were willing to exchange viewpoints and listen (not necessarily agree) to each other, we might have a shot at digging our way out of this mess…


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