“North Carolina Gov. Pat McCrory (R) made clear Tuesday that he doesn’t want any part of the coverage expansion under President Obama’s signature healthcare law. McCrory rejected the law’s Medicaid expansion and said he doesn’t want to work with the federal government to retain some control over his state’s insurance exchange. He’ll cede that power entirely to the Obama administration.”

“The feds may not have provided an estimate of the cost of operating an exchange, but several other experts have. The results are eye-popping. According to Maryland’s Joint Committee on Health Benefit Exchange Financing, administrative costs alone will run the state an astounding $201 per person in 2015. The auditing firm KPMG recently found that Ohio can expect to spend $63 million to set up its exchange and another $43 million each year to run it.”

“The Obama administration is late in implementing several provisions of the federal health overhaul intended to improve access to care and lower costs. The programs, slated to take effect Jan. 1, were supposed to increase fees to primary care doctors who treat Medicaid patients, give states more federal funding if they eliminate Medicaid co-pays for preventive services and experiment with changes to how doctors and hospitals are paid by Medicare.”

“A major criticism of the Affordable Care Act (ACA) is its attempt to impose “one size fits all” health policy on states with
different populations and markets. Whereas health insurance was historically regulated by the states, the ACA and
accompanying regulation imposes numerous new rules onto health insurers and employer-provided plans. Millions of
Americans will be eligible for subsidized health insurance coverage in 2014, and supposedly able to enroll in said
coverage by October.”

“Months since the Supreme Court ruling that made the Obamacare Medicaid expansion optional, the state costs associated with expansion still remain highly uncertain—making expansion a dicey course for states and their budgets.
Indeed, states should not lose sight of the fact that the original Medicaid expansion was coercive for a reason.”

“Thus, as it now stands, only 14 to 16 states (plus the District of Columbia) are likely to actually be operating state-run exchanges come October, when open season begins. There may be another two or three states with so-called partnership exchanges, but the feds will be responsible for most of the major functions in those states. Indeed, the final count could be lower as some states trying to set up their own exchanges—faced with significant technical challenges and limited remaining time—give up and default to a federally run exchange.”

“Having failed to persuade 26 states that participating in ObamaCare is a good deal, the liberals behind the law are denouncing these dissident Governors as federalist hypocrites. A few critics on the right are chiming in and arguing that the 26 are inviting worse results once the feds swoop in. So someone ought to say a word on behalf of the people who run state governments in the real world and have examined the health insurance ‘exchange’ question in detail. They’ve seen enough to know that the choice to set up and run these insurance bureaucracies is not a choice at all.”

“The federal government will likely be involved in running the ObamaCare exchange in at least 30 states, 26 of which expressly declined to establish state exchanges. One health-policy expert refers to it as an ‘administrative nightmare’ for the Department of Health and Human Services. Friday was the deadline for a state to let HHS know if it planned to establish a state exchange. Thus far only 18 states and the District of Columbia are planning on doing so.”

“Pennsylvania will not set up its own health care exchange under the federal Affordable Care Act, at least not for now, Gov. Tom Corbett said Wednesday, putting the state on a course to join others led by Republicans that will let President Barack Obama’s administration run its exchange. Setting up a state-based exchange would be irresponsible, Corbett said, as he faulted federal authorities for what he called inadequate answers to his questions about cost and other issues.”

“Recent decisions by the Obama Administration concerning the health care exchanges and Medicaid expansion underscore what a risky proposition the Patient Protection and Affordable Care Act (PPACA) is for the states. Congress presumed in PPACA (Obamacare) that the states would agree to build and run exchanges and could be forced to expand Medicaid. The Supreme Court, however, ruled the Medicaid expansion voluntary, which has made states increasingly concerned over new burdens related to costs, control, and coverage—in both the exchanges and Medicaid.”