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Texas is almost alone among the nation’s largest states in failing to start work on a key piece of the Affordable Care Act, as legislators and state agencies follow Gov. Rick Perry’s dictum to delay action until after a Supreme Court ruling and the November election.
“Politics superseded good policy,” state Rep. Garnet Coleman, D-Houston, said of the inaction on creating an exchange to help small businesses and individuals buy health insurance.
Texas is one of nine states – other than Florida, the others are mostly small, with relatively few uninsured residents – identified by the Kaiser Family Foundation as having made “no significant progress” toward establishing an exchange. A Perry spokeswoman said there are no plans to change that.
“(Perry) feels the health care bill is unconstitutional and misguided,” spokeswoman Lucy Nashed said. “There are no plans to implement an exchange.”
But analysts say the delay makes it more likely the state will miss a Jan. 1, 2013, deadline for proving a state exchange is on track. If it’s not, the federal government will impose its own exchange.
People shopping for insurance through the exchanges may not notice the distinction – those with incomes up to about $88,000 for a family of four would qualify for subsidies in a federal exchange, just as they would in a state-run pool.
But it’s likely to add fuel to recent anti-federal regulation fervor. A 2011 survey by Texas A&M University’s Public Policy Research Institute found 63 percent of Texans preferred a state exchange to a federal operation. Almost 40 percent felt the state should not set up an exchange.
“The risk is that the federal exchange may not look exactly like the state exchange would,” said Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation. “If you wait for some of these critical milestones (such as the Supreme Court ruling), states may not have enough time to get an exchange up and running.”
Most provisions of the law begin in 2014, and the exchanges are central to finding affordable health insurance and qualifying for subsidies.
High national rate
People with incomes up to 133 percent of the federal poverty level – about $14,400 for a single person – will be covered by an expansion of Medicaid, the federal-state program for low-income residents. It now covers mainly children, the disabled and low-income elderly people.
The exchanges are aimed at most other uninsured residents. At 24.6 percent of the population, Texas has the highest rate in the nation.
Opponents see two ways to overturn the law.
The Supreme Court will hear arguments next month and is expected to rule this summer on whether the mandate requiring health insurance is constitutional. It also must decide whether the rest of the law can be implemented without a mandate. The presidential election presents another chance; the Republicans vow to repeal it.
State Rep. John Zerwas, an anesthesiologist and Richmond Republican, unsuccessfully pushed a bill to create an exchange last year. “It was the desire of the governor to take a wait-and-see position, in light of the fact that it was being challenged (in court), and in consideration to what might happen in November,” Zerwas said.
He and other officials said Perry could create an exchange by executive order;Nashed said Perry has no plans to do so.
Zerwas said he believes an exchange could help the uninsured, especially those who own or work for a small business.
Tainted by Obamacare
“The problem with an exchange is, it got synonymous with Obamacare and it was tainted,” he said.
According to the Kaiser Family Foundation, 13 states and the District of Columbia have established exchanges. Arkansas and Louisiana will use a federal exchange or work with the federal government. Work is ongoing in most other states.
Texas is farther along in preparing for the Medicaid expansion, thanks to a waiver granted by the federal government late last year that could provide as much as $29 billion over five years to expand and improve care.
Coleman said that money also could be used to train more health care providers, including primary care physicians and nurse practitioners.