Under ObamaCare, states are given the option of creating a state-run health insurance exchange to implement ObamaCare in their state, a federal-state partnership health insurance exchange, or refuse to implement a state exchange and force the federal government to implement an exchange. In a previous post, I wrote about how state health insurance exchanges are the federal government’s way of passing along the cost of implementing ObamaCare to the states, detailing how much more expensive it is for a state to implement a health insurance exchange as compared to the costs the federal government faces when implementing a health insurance exchange for a state. Connecticut, the first state to be approved for a state health insurance exchange by the Department of Health and Human Services, is now experiencing firsthand how difficult it is for a state exchange to keep up with the expansive health care regulations put into place by the federal government as part of ObamaCare.

Despite Connecticut being one of the states the furthest along in creating a health insurance exchange for their residents, the CEO of Connecticut’s exchange program, Access Health CT, has announced that the exchange has stopped implementing any new federal regulations as of March 1. Kevin Counihan, the CEO of Connecticut’s public health insurance exchange, made the announcement that Connecticut would not be implementing any new ObamaCare regulations in an interview with the Associated Press, saying that “If [the federal government] keep[s] adding new regulations, I’m sorry. We have to suddenly say, ‘enough is enough.’” According to the Associated Press report, Counihan has said that any new ObamaCare regulations would be addressed by Access Health CT “later,” though no actual date for when “later” would be has been specified. Simply put, the federal government continues to create new regulations for the implementation of ObamaCare, and before the state exchanges created to implement ObamaCare have even been put into place, the regulations faced by states implementing insurance exchanges have proven to be too burdensome.

Although Counihan’s announcement regarding the implementation of new ObamaCare regulations in Connecticut is significant, other revelations from the Access Health CT CEO’s interview with the Associated Press provide additional insight into just how problematic implementing ObamaCare is going to be for states that made the decision to create their own state-run health insurance exchange.

In his interview, Kevin Counihan predicted that it would take at least three to four years for Connecticut’s state-run exchange to iron out any problems the exchange may have, and that it would take at least four to five years for the exchange to reduce the number of uninsured Connecticuters. These predictions are made by Counihan under the current state of federal ObamaCare regulations, though the number of regulations is certain to increase, as the recent Access Health CT decision shows. As the federal government creates more and more regulations for the implementation of ObamaCare, the number of problems associated with Connecticut’s state health insurance exchange is likely to increase as well.

The Associated Press’ story on Connecticut’s health exchange problems makes note of the fact that Connecticut is one of the states that is one of the “furthest along in preparing to enroll patients in the new health insurance marketplace.” As other states reach the same point in implementing their own state exchanges that Connecticut has currently reached, these states will face the same regulatory burdens that Access Health CT is currently struggling with, and may make the same decision to halt the implementation of any new federal ObamaCare regulations. It was already well known that ObamaCare is an unnecessary, expansive government overreach into the American health care industry, but state exchanges that are unable to handle the massive regulations put into place by the federal government show just how expansive and burdensome ObamaCare is on states and taxpayers, now and in the future.

Today marked what was to be the final deadline for states to submit their plans for a state-federal partnership to set up a health insurance exchange in order to comply with ObamaCare.  However, with 27 states currently refusing to set up their own exchange, the Department of Health and Human Services (HHS) now finds itself needing to set up its own exchange in each of these states before the statutorily mandated October 1st deadline.

Grassroots activists have made their mark on the fight, sending nearly 40,000 messages via blockexchanges.com to let their top state officials know that assisting the government in creating an exchange is unacceptable.  In North Carolina alone, over 6,700 people sent messages to Governor McCrory, who finally decided to overturn the exchange that had been started by his predecessor Gov. Bev Perdue.

Below is a map showing where each state stands on the health insurance exchanges:

HHS has responded to the states’ resistance with increasing desperation.  They have repeatedly pushed back the deadlines for states to start setting up an exchange.  In states which are working with the government to set up an exchange, the deadlines to finalize their exchanges have been suspended entirely. The administration has also attempted to re-brand the exchanges, attempting to convince the states that HHS will not be too intrusive in the insurance markets (while still noting that the feds will have the final say on everything).  Finally, starting in 2013, HHS has tried to make the exchanges sound more friendly by calling them “marketplaces”.

Despite pressure from HHS and the insurance industry, governors and legislators in a majority of the states recognized that setting up their own exchanges would be a bad deal, in which states absorb the cost and effort while the government keeps absolute control.

Even if the administration succeeds in setting up all of the exchanges in time (which seems increasingly unlikely), ObamaCare faces an obstacle of its own making – a defect in the text of the Patient Protection and Affordable Care Act (PPACA) that does not allow federally created exchanges to fully work.  The law specifies that only state-created exchanges can distribute the premium subsidies that are necessary to entice people to participate in the exchange, and also makes it impossible for a federal exchange to effectively enforce the mandate that forces businesses to insure its employees.  You can find a more detailed breakdown of how this causes ObamaCare to break down HERE and HERE.

And all that states had to do to throw a wrench in ObamaCare was refuse to comply with an expensive, cumbersome, intrusive government mandate.

Remember that even now states which have opted out of the exchanges can choose to take over operation of the federal exchanges.  See where you state stands, and Take Action at blockexchanges.com!

Washington, DC - FreedomWorks applauds North Carolina Governor Pat McCrory’s announcement yesterday to resist a state health insurance exchange, leaving that task to the federal government.

Governor McCrory’s decision to reject the state exchanges overturns the actions of the previous Governor, Bev Perdue, who had started the process of setting up a state-federal partnership exchange before her electoral defeat last November.

FreedomWorks VP of Health Care Policy Dean Clancy commented, “Grassroots activists across the state have been at the forefront of the effort to stop North Carolina’s insurance exchange, sending over 6,700 messages to Governor McCrory and top state lawmakers. We are encouraging our activists to use this momentum to keep the pressure on the state legislature to finish the job and pass their bill to block state-run exchanges in the future.”

Health care exchanges are the bureaucratic mechanism for operating ObamaCare in the states, and the distribution point for the billions of dollars in premium subsidies to insurance companies which will supposedly help people afford insurance. Although states can choose to run their own exchanges, the federal government retains ultimate control over all major decisions, while the states have to bear the costs.

Clancy explained, “Currently, the President’s health care law does not allow the insurance subsidies necessary for ObamaCare to be distributed through a federally created exchange. If we can successfully incentivize Congress to reopen the health care law, it will give us a chance to delay and dismantle it and start over with real, patient-centered reforms.”

“About twenty-eight states have taken the first step in making that happen by refusing to set up state exchanges, and our activists across North Carolina plan to keep the pressure on the legislature to pass the bill to block these exchanges.”

FreedomWorks is a grassroots service center to a community of over 2 million activists dedicated to advancing the ideas of individual liberty and constitutionally-limited government. For more information on FreedomWorks’ health care position, please visit www.BlockExchanges.com  or contact Jackie Bodnar at Jbodnar@FreedomWorks.org.

Utah is the 28^th state to refuse to adopt a federal health care exchange

 Washington, DC- Following news that Utah Governor Gary Herbert walked away from negotiations with the Obama Administration to create a federally approved health care exchange in the state, FreedomWorks Vice President of Health Care Policy Dean Clancy issued the following statement:

“Governor Herbert’s resistance to a federally-approved health care exchange in Utah is a silent protest of the unconstitutional federal law, and he should be applauded for it. Governor Herbert made the right choice – to join the majority of states who are standing against the federal takeover of their health care. If enough states refuse to create their own health care exchange, we may be able to dismantle ObamaCare even with President Obama in office.”

Governor Herbert’s resistance follows the Obama Administration’s decision in January to indefinitely extend the deadline for states to adopt health care exchanges, an admission of defeat for the White House and further evidence for the lackluster enthusiasm surrounding the President’s unconstitutional health care law.

Health care exchanges are the bureaucratic mechanism for operating ObamaCare in the states, and the distribution point for the billions of dollars in premium subsidies to insurance companies which will supposedly help people afford insurance. Although states can choose to run their own exchanges, the federal government retains ultimate control over all major decisions, while the states have to bear the costs.

Clancy explained, “It’s crucial for grassroots activists to urge their Governors to block the health care exchanges, because the ‘Unaffordable Care Act’ as written does not allow the insurance subsidies that are crucial to ObamaCare to be distributed through a federally created exchange. In order to prevent a train wreck, Congress is going to have to reopen the health care law, and that gives us a chance to delay and dismantle it and start over with real, patient-centered reforms.”

“About twenty-eight states have taken the first step in making that happen by refusing to set up state exchanges, and our activists across the country plan to remain vigilant and to keep the pressure on their Governors to stand their ground.”

FreedomWorks is a grassroots service center to a community of over 2 million activists dedicated to advancing the ideas of individual liberty and constitutionally-limited government. For more information on FreedomWorks’ health care position, please visit www.BlockExchanges.com  or contact Jackie Bodnar at Jbodnar@FreedomWorks.org.

Idaho is among the reddest of red states, and would seem to be an obvious frontrunner among the states resisting ObamaCare’s health care exchanges.  Indeed, Idaho Governor C.L. “Butch” Otter has long been a vocal opponent of ObamaCare, and even signed an executive order banning his state’s employees from enforcing ObamaCare.

And yet, Gov. Otter vetoed a bill to ban health care exchanges, and eventually announced that  Idaho would set up a fully state-run health care exchange.  In his veto letter to the legislature, Gov. Otter declared that

Under ObamaCare, individual states retain control of the creation of an insurance exchange. The fact is, the federal government will develop and operate an exchange for us if Idaho elects to forgo the creation of our own exchange…

The problem with this logic, as most other Republican governors have realized, is that the states do not have the final say over any of the most crucial aspects of the exchanges.  The federal government still decides what insurance plans comply with ObamaCare, they still decide who gets health care subsidies and how much, and they still use the exchanges to help enforce the unconstitutional health care mandates.  State control over exchanges is merely a veneer over the federal leviathan that effects the “Affordable Care Act”.

Nebraska Governor Dave Heinemann summed up the nature of health care exchanges nicely:

A state exchange is nothing more than the state administering the Affordable Care Act with all the important and critical decisions made by the federal government.

Fortunately, a number of Idaho’s state legislators continue to oppose the exchange, and there is still time to push the Governor to reverse his course.  Idaho residents can visit FreedomWorks’ action page to contact the top state officials by email and phone and urge them to stand against ObamaCare.

The Idaho Freedom Foundation is also collecting a petition asking state officials to cease implementing a health care exchange.  You can sign the petition HERE.

Over half of the states are currently standing against the government’s unprecedented takeover of health care, and it’s not too late for Idaho to join them!  Find out where all the states stand, and more information on the exchanges, at blockexchanges.com.

In his second inaugural address on January 21, 2013, President Barack Obama stated that “we must make the hard choices to reduce the cost of health care and the size of our deficit.” With regard to health care, all indications are that the price of health insurance will increase as a result of ObamaCare, with the federal government attempting to pass along these costs to the states by asking them to implement state-run health insurance exchanges.

Currently, 27 states have decided to avoid implementing state-run exchanges in favor of federal health insurance exchanges. What is the motivation behind these decisions at the state level? The simple answer is that state-run exchanges are an attempt by the federal government to pass on the cost of ObamaCare to the states, while offering states no control over their own exchanges. Given the high costs of state-run health insurance exchanges and the potential for even higher costs as the price of insurance increases under ObamaCare, it is no surprise that states want to avoid the significant financial burdens associated with implementing their own health insurance exchanges.

Nebraska is a perfect example of a state eager to avoid the high costs that a state-run health insurance exchange would bring to the Cornhusker State. In the November 2012 press release in which Nebraska announced that the state would participate in a federal health exchange, it was revealed that a state-run health insurance exchange would cost the state an estimated $646 million from 2013 to 2020 for an average annual cost of nearly $81 million. For comparison, a federal health insurance exchange in Nebraska would cost the federal government only $176 million over the same period, a difference of $470 million over the course of eight years. Of the cost difference between state-run and federal-run exchanges, Governor Dave Heineman stated that “it is simply too expensive to do a state insurance exchange.”

In New Jersey, Governor Chris Christie vetoed a measure passed by the New Jersey legislature which would have created a state-run health insurance exchange. Estimates show that such a state-run exchange would have cost New Jersey $100 million dollars each year in operating costs. In justifying his veto, Governor Christie wrote in his message to the New Jersey Senate that “financing the building and implementation of a State-based Exchange would be an extraordinarily costly endeavor,” and that “the total price for such a program has never been quantified, and is likely to be onerous.” By vetoing legislation which would have set up a state-run exchange for New Jersey, Governor Christie was able to avoid a burden of $100 million for the taxpayers in his state, a burden that would certainly increase over time with the rising price of health insurance as a result of ObamaCare.

Wisconsin, led by Governor Scott Walker, is another state which has acted to avoid the high costs that would result from the implementation of a state-run health insurance exchange. Estimates from the Walker administration indicate that implementing a state-run health insurance exchange in Wisconsin would lead to an annual operating cost between $45 million and $60 million. For Governor Walker, the estimated annual cost would be too much to pass along to taxpayers, saying that “if the state option is chosen…Wisconsinites face risk from a federal mandate lacking long-term guaranteed funding.” By avoiding the $45 million to $60 million annual costs associated with a state-run exchange, Wisconsin is also avoiding the potential for higher annual costs in the future, with estimates showing that ObamaCare will lead to an average increase in individual insurance premiums in the state of 30 percent by 2016.

In Ohio, estimates from the state’s Department of Insurance indicate that setting up a state-run health insurance exchange would cost as much as $63 million, followed by costs of $43 million to run the exchange each year. Among the reasons why Ohio decided to avoid a state-run exchange, Governor John Kasich lists “higher health insurance costs, significant uncertainty in [Ohio’s] insurance market and major new costs to states.” Instead, it will cost the federal government only $21 million to set up its health insurance exchange in Ohio, with smaller operating costs than those which the state of Ohio would have incurred with a state-run exchange. In addition to avoiding the cost of implementing ObamaCare from being passed along to them by the federal Government, Ohio is also avoiding the possibility of higher annual operating costs in the future. According to projections from the Ohio Department of Insurance and the actuarial consulting firm Milliman, it is estimated that individual health insurance premiums in Ohio will increase by 55 to 85 percent by 2017.

When ObamaCare became law, no funds were authorized by congress to pay for federal health care exchanges, a major reason why the federal government is attempting to pass along the cost of ObamaCare to each individual state. Despite President Obama’s goal to reduce the cost of health care, ObamaCare is poised to do the opposite, increasing the cost of health coverage for individuals across the United States. As a result, states which have refused to set up a state-run exchange have put themselves in a position to avoid already-high exchange implementation costs, as well as future operational costs, which will undoubtedly increase as the price of insurance increases across America.

The more forgiving among us may feel some genuine pity for Health and Human Services Secretary Kathleen Sebelius. On one hand, President Barack Obama loaded her department with the mammoth task of writing up the thousands of rules and regulations that will constitute the real weight of ObamaCare. On the other, he charged Secretary Sebelius with the even more onerous duty of convincing a (rightfully) skeptical American public that the new 2,801 page health care reform law represented a landmark achievement that would benefit all citizens. So far, this hasn’t gone so well.

The law remains unpopular to this day due to failure in the realms of principle, policy, constitutionality, and public relations. This lingering unpopularity has led to serious real-world consequences for the law itself. As Joshua Withrow noted before, a stunning majority of states have refused to set up their own state “exchanges,” which are the basic machinery through which ObamaCare is meant to operate.

Unless these states undergo an inexplicable change of heart, this means that Secretary Sebelius’s department will now take on the added responsibility of creating a majority of the state health insurance “exchanges.” In fact, her department has so far only granted “conditional approval” to seventeen proposed state “exchanges,” so the number may end up even higher than twenty-seven. It goes without saying that creating just one of these exchanges is not a cheap, simple, easy, or quick process.

Remember, the clock is ticking on ObamaCare’s implementation.

On October 1st of this year, citizens will supposedly be able to purchase health insurance through these “exchanges,” with their coverage beginning on January 1st, 2014.Secretary Sebelius, in fear of this fast-approaching implementation deadline, has graciously (read: desperately) decided to extend or even outright waive the deadline for states to set up their own “exchanges.”

This isn’t the first time that Secretary Sebelius has postponed this particular deadline. Originally, states were meant to submit their proposals to her department on November 16th of last year. However, well aware that a large majority of states would not meet that deadline (or had any intentions of trying), she delayed it on November 9th to December 14th while demanding that those states that did intend to create an “exchange” must submit a brief “letter of intent” along those lines by the original deadline of November 16th.

This new deadline didn’t work out so well, either. On November 15th, when Secretary Sebelius finally realized that those “letters of intent” probably weren’t in the mail, she ditched that idea and admitted that the letters could be sent on December 14th, as well. However, she insisted that she would make a final decision on January 1st of this year regarding which states would be allowed to create their own “exchanges.” Surely, this would be the final deadline.

As you might suspect, it didn’t turn out to be the final deadline. On January 14th, Secretary Sebelius admitted that she would still accept proposals from states that desired to create their own “exchanges.” In fact, she will now “waive or extend the deadline” for those states. Perhaps to preserve a shred of dignity, her department claims that proposals for “partnership exchanges” between states and the federal government must still be submitted by February 15th.

It’s fair to ask whether Secretary Sebelius is “kicking the can down the road” on the issue of ObamaCare implementation. Well aware that her department is ill-prepared (if not completely incapable) of taking on the gargantuan burden of creating dozens of state “exchanges” by itself, she has continually pushed back this key deadline. Now, there is no true deadline, other than the planned starting date of October 1st.

Is there still time for her department to create these “exchanges?” Not if you were to ask Dan Mendelson, president of consulting firm Avalere Health.

The Washington Post quoted Mendelson as saying that, “It would be very hard at this point to start from scratch. I’m not going to say it’s impossible, but it would be unlikely.” To be fair, he was discussing recalcitrant states and not the Department of Health and Human Services, but that only makes it worse. A state only needs to construct a single exchange. Secretary Sebelius will have to build dozens. Also, keep in mind that Mr. Mendelson provided this opinion months ago on November 9th. The situation has only grown more dire for Secretary Sebelius since then, as so much precious time has elapsed.

Secretary Sebelius has a hard job. However, she is engaging in pure self-delusion if she believes that repeatedly pushing back these deadlines will cause the states resisting ObamaCare to flock under its banner in these final months. The longer she holds out baseless hope along these lines, the less time her department will have to slap together a pile of last-minute “exchanges.”

As FreedomWorks’ Vice President of Health Care Policy Dean Clancy put it, “The wheels are coming off the bus, and the Administration is getting desperate.” It’s time for Secretary Sebelius to admit the obvious: a majority of states in the Union do not support ObamaCare and do not want to participate in it.

It’s that simple.

WASHINGTON, DC- Following news that the White House extended the February 15th deadline for states to adopt health care exchanges for a second time, this time indefinitely, FreedomWorks’ Vice President of Health Care Policy Dean Clancy commented:

“The decision to postpone the Governors’ exchange deadlines is a silent defeat for the White House. We knew we were winning the fight against government-run health care when 27 states -more than half- refused to adopt a federal exchange. Today’s annoucement only confirms that Health and Human Services will not be able to meet the February 15th deadline. The wheels are coming off the bus, and the Administration is getting desperate. FreedomWorks is emboldened by this silent admission of defeat, and we plan to redouble our efforts to block the ObamaCare exchanges and to pressure Congress to reconsider this misguided, unconstitutional law.”

FreedomWorks is a grassroots service center to a community of over 2 million activists dedicated to advancing the ideas of individual liberty and constitutionally-limited government. For more information on FreedomWorks’ health care position, please visit www.FreedomWorks.org, or contact Jackie Bodnar at Jbodnar@FreedomWorks.org.

Today is an important day – we’re one giant step closer to reversing the government takeover of our health care.

The deadline for states to begin setting up their own, state-run health care exchange under ObamaCare was today, December 14th. This deadline was a crucial trial for ObamaCare, and the verdict is in — 26 states, a majority of the union, are currently declining to set up an exchange.

Below is a map of how each state stands on the exchanges:

Many states took a long time to decide their course of action, and even some solidly anti-ObamaCare governors appeared to wrestle with the idea of creating a state-run exchange. In the end, though, most realized that creating a state exchange would just set their states up to bear millions of dollars in costs, while increasing the costs of health care for all of their residents.

And, of course, having several thousand concerned citizens flooding their inboxes and phone lines certainly entered into these states’ calculus.

FreedomWorks’ grassroots activists made their own impact on their states’ decisions, sending over 35,000 messages to their top state officials, asking them to stand against ObamaCare’s costly mandates by refusing to set up an exchange.  Many of these states subsequently declared their intention to opt out of the exchanges, including Wisconsin, Alabama, Georgia, Pennsylvania, Tennessee, and Arizona.

You can read a more detailed explanation of why it is so crucial that states force the federal government to set up the exchanges HERE.  But it boils down to this – the “Affordable Care Act” as written does not allow the insurance subsidies that are crucial to ObamaCare to be distributed through a federally created exchange.  In order to address this major flaw, Congress is going to have to reopen the health care law, and that gives us a chance to dismantle it and work on real, patient-centered reforms.

The states have taken the first step in making that happen – ObamaCare is in peril – but now the next step begins. States have until February to partner with the government to create a hybrid state/federal exchange, which would be just as bad as setting up a state-run exchange in most ways.  So it will be crucial to remain vigilant, and to keep the pressure on the states to stand their ground.

But so far, so good.

States should not implement health insurance exchanges as defined by Obamacare. There is no fiscal advantage to doing so. An exchange will not improve life for a state’s citizens, and there is great risk of political liability for officials responsible for an exchange.

The House Energy and Commerce subcommittee on Health held a hearing today at 10:00am to try to pry from DHHS bureaucrats answers to some of the huge number of unanswered questions about implementation issues facing the states. See below for a list of the questions.

You can find out where your state stands and help block the further expansion of government into health care.

Douglas Holtz-Eakin writes at NRO  that since Obamacare was passed and upheld in the courts, President Obama’s reelection represents the third strike against repeal efforts, and therefore against efforts to combat the implementation of state exchanges. That presumes, however, that state-based exchanges are a worthwhile endeavor.

Mario Loyola, also at NRO, counters:

Holtz-Eakin’s basic position is that states will be able to control many aspects of the exchanges and that’s better than letting the federal government set them up and control them

… which they will not be willing to do. Loyola quotes Holtz-Eakin:

States can, and should, control their destinies by deciding how their exchanges will function, which private insurance companies can participate, and what kind of insurance coverage will be offered.

Deciding which private insurance companies can participate in the marketplace should not be a function conservatives want government to pursue.

States will not be able to shape their exchange marketplaces in any meaningful way beyond choosing the individual companies involved, based on little more than how effective the companies are at lobbying. It is a recipe for cronyism, kickbacks, and corporatism.

“One of the most important limits on federal power,” continues Loyola, “is that the feds normally have to implement and be accountable for their own policies. It is precisely that limit that the federal government escapes when it deputizes state governments into doing its bidding.”

Holtz-Eakin says that the federal exchanges (which are really to be one exchange tailored by ZIP code) are a trojan horse for single-payer.

Implementation opponents respond with a modified Cloward-Piven strategy: if the feds want to build an exchange to serve the states, let them try. Since they can’t the way Obamacare is designed, the whole law will have to be reopened and then can be shelved for real, presumably bipartisan, reform.

The Cato Institute’s Michael Cannon lists the reasons not to implement. Summarized, they are:

1. States are under no obligation to create one, and can always create an exchange later if they choose. 14 states have laws or constitutional provisions against doing so.
2. A state-created exchange is not a state-controlled exchange. All exchanges will be controlled by Washington.
3. Creating an exchange sets state officials up to take the blame when Obamacare increases insurance premiums and denies care to the sick. State officials won’t want their names on this disastrous mess.
4. The arbitrary December 14 deadline is no different that the arbitrary November 16 deadline, or the “deadlines” for implementing REAL ID, which have been pushed back repeatedly since 2008.
5. Each exchange would cost its state an estimated $10 million to $100 million per year, necessitating tax increases.  The grants to create the exchanges only last the first couple of years, after which states are on their own. Nina Owcharenko and Edmund F. Haislmaier of Heritage note that just running the exchanges will add about 3.5% overhead to the cost of insurance.
6. Congress must authorize funds for federal “fallback” exchanges before they can operate, giving the House leverage.
7. Creating an exchange would be assisting in the creation of a “public option” that would drive domestic health-insurance carriers out of business through unfair competition.
8. Obamacare remains deeply unpopular. The latest Kaiser Family Foundation poll found that only 38 percent of the public supports it.
9. Defaulting to a federal exchange exempts a state’s employers from the employer mandate. Jimmy John Liautaud, founder of Jimmy John’s subs, said Obamacare implementation would cost 50 cents per sandwich, without insuring anyone or paying a single fine. “If you have 40 or 50 employees at a restaurant, and the penalty is $2,000, and you’re going to pay $80,000 or $100,000 penalty, there goes the profit in your restaurant.”
10. Avoiding those taxes improves a state’s prospects for job creation, and protects the conscience rights of employers and individuals whom the Obama administration is forcing to purchase contraceptives coverage.
11. Rejecting an exchange reduces the federal deficit. Obamacare offers its deficit-financed subsidies to private health insurers only through state-created exchanges. If all states declined, federal deficits would fall by roughly $700 billion over ten years.
12. The Obama administration has yet to provide crucial information that states need before they can make an informed decision. Ahead of today’s hearing, unanswered questions include:
    •  What benefits must be included in qualified health plans under rules dictating “essential” health benefits?
    • When will HHS reveal the operational details of the federal exchange?
    • Has HHS accounted for the subsidy cliff included in PPACA that dramatically increases an individual’s and family’s exposure to the law’s premium increases?
    • Has HHS considered the potential disruption to insurance markets due to the details of the law’s government-run plan administered by the Office of Personnel Management?
    • Will States have the ability to opt in or out of an exchange management on an ongoing basis given the lack of information related to the operation and cost of these exchanges?
    • Will the Administration again change deadlines related to implementation of State exchanges given the lack of information provided by the Administration?
    • Will States that expand Medicaid coverage up to a level below 133 percent of the Federal poverty limit (FPL), for example up to 100 percent FPL, still receive the enhanced Federal medical assistance percentage (FMAP) available for “newly covered” populations?
    • Will States be allowed to phase in Medicaid coverage up to 133 percent of FPL in years after 2014 and still receive the enhanced FMAP?
    • If a State opts not to pursue Medicaid expansion as written in the PPACA, what other Medicaid provisions of PPACA would apply to their State programs? Specifically, do financial penalties associated with the PPACA Maintenance of Effort provisions still stand?
    • What options and Federal assistance are available for States that decide not to pursue Medicaid expansion as written in the PPACA?
    • What additional flexibilities are available to States that may be considering an expansion but conclude the financial sustainability of such a policy requires greater State autonomy in managing their Medicaid programs?
    • Regarding the two-year increase in Medicaid reimbursement for primary care codes, are States expected to maintain the additional billions in spending after 2014?

States should not implement health insurance exchanges as defined by Obamacare. They limit freedom. The only people to win with a state-based exchange are the politically connected cronies. Voters unhappy with the direction of health care reform will surely punish those officials who line their own pockets in pursuit of it.