Red States Overwhelmingly Choose to Hand Over Health Care Reins to the Feds

On February 15, the deadline passed for states to decide whether to run health insurance exchanges in partnership with the federal government, or to leave it to the federal government entirely. The deadline for state-run exchanges had already passed in December.

The official count is in: the federal government will be running 26 exchanges for the states - the same states that theoretically hate "big government."

The graphic to the left from the Washington Post shows a stunning clash of supposed principles vs. politics, with basically all of the blue states taking on local ownership of the exchanges, and the red states ironically leaving it to the feds.

The good news is that regardless of who runs it, Texas is getting a health insurance exchange. And it's not actually clear whether it will be better or worse for Texas to have the federal government holding the reins. On one hand, Texas has given up on designing an exchange that conforms to state needs. On the other hand, Texas does not have a great track record on the aspects of health policy that it does control.  

The Advisory Board Company

The same inevitability does not, however, exist for Medicaid. A Medicaid expansion will begin on January 1, 2014, for states choosing to accept it. In a similar proportion to the health insurance exchanges, only 24 governors are allowing the expansion.  

However, last week, Governor Chris Christie of New Jersey became the eighth Republican governor to allow an expansion of Medicaid under the Affordable Care Act in his state.

In a statement that should resonate quite loudly in Texas, he explained, "Let me be clear: Refusing these federal dollars wouldn't mean they would not be spent. It just means they would be spent to expand health care access in New York, or Connecticut, or Ohio, or somewhere else."

And that's exactly the choice that Rick Perry has made for Texas - to allow its federal tax dollars to be spent elsewhere.

In Texas, rejecting the Medicaid expansion means the state is passing up on insuring an additional two million people and drawing down over $100 billion in federal funds. And for what?

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