Good roundup last night on Marketplace on the question of whether to have states or the federal government run the health-insurance exchanges. Arkansas announced yesterday that for now the state will go with a partnership with the feds.
Really hard to say at this point which approach will yield better results. The feds are charging an additional 3.5 percent fee on policies sold on a federally run exchange, but most consumers will not be impacted.
My guess is that states running their own exchanges are likely going to be at least mildly more efficient and less costly — and thinking nationally, I’d expect you’d see more innovation with each state tackling the problem in its own way. On the other hand, a federally run exchange might be marginally to the left of one run by Arkansas, via more regulation of insurance companies on the exchange. But no one really knows. And again, the impact on consumers is likely to be negligible, both in terms of quality of service and premium price.
The funny thing is that the sort of people that should really, really want state control are conservatives of a strong federalist bent. And they’re the very folks that have ceded control to the big, bad federal government because opposing any and all things Obamacare is their all-consuming obsession.