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Posted at 5:37 PM ET, 02/ 8/2011

More on Mitch Daniels's health-care deal

By Ezra Klein

Earlier today, I asked what exactly Indiana Gov. Mitch Daniels meant when he said "all the [Affordable Care Act's] expensive benefit mandates [should be] waived, so that our citizens aren't forced to buy benefits they don't need and have a range of choice that includes more affordable plans."

I just got off the phone with Seema Verma, who is advising Daniels on health-care policy. She emphasized that Daniels is talking about the so-called essential benefits package, not regulations such as the one preventing insurers from discriminating against preexisting conditions. And in her telling, Daniels doesn't want the standards for insurance products waived so much as he wants the responsibility for setting those standards handed over to the states. "We haven't sat around coming up with an essential benefits plan of our own," Verma says. "But the fear is that by defining it on the national level, who knows what they’re going to come up with? That decision-making process should happen at the local level."

This essentially preserves the status quo on insurance mandates. Right now, states decide what insurers have to cover. And as this ever-helpful report (PDF) from the Council for Affordable Health Insurance shows, Indiana has its own basket of demands. Where New Mexico names 57 different classes of care that insurers must cover and Idaho names only 13, Indiana holds it to 34, including surgeries for cleft palettes, colorectal cancer screening, treatment for morbid obesity, mastectomies, alcohol and substance abuse treatment, and quite a few more. So perhaps it's not surprising that Daniels wants control of this decision.

What's not so surprising is that a governor such as Daniels is the first major Republican to come out with a concrete set of reforms he'd like to see made to the law. Unless the Affordable Care Act is repealed in Congress or voided by the courts, governors have two choices: Set it up themselves or let the federal government do it for them. They can't ignore it. They can't put it off. They simply have to figure out a way to live with it. That seems to be what Daniels is doing here. But though he addresses his comments to the Obama administration, I suspect that reforms along the lines he's proposing might be a harder sell among congressional Republicans.

By Ezra Klein  | February 8, 2011; 5:37 PM ET
Categories:  Health Reform, Health reform implementation  
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Comments

great follow up Ezra. There goes the theory that Republicans want people to "die quickly" due to being subject to pre-existing conditions.
Great report from CAHI as well. I've seen those before but not this recent of an edition. You want to know why premiums are high, look there. Its a great barometer.

Posted by: visionbrkr | February 8, 2011 6:58 PM | Report abuse

Nothing in the statute gives reason to believe that the essential benefits package will be defined to exceed current state requirements. The law provides guidance as to how regulations defining the essential benefits should be devised. Regulations implementing the law will ensure that the essential benefits are those “benefits typically covered by employers” and are “equal to the scope of benefits provided under a typical employer plan.” This approach should lead to a federalization of minimum standards of coverage already required by the states.

Posted by: DRies | February 8, 2011 7:05 PM | Report abuse

Once again I'll ask -- If a state Governor does not sign a state statute authorizing state funding for the state's implementation of the Obama/Pelosi PPACA, who PAYS for the implementation?? Under such a circumstance, Congress would need to authorize additional federal funding to "let the federal government do it".

It's a powerful position for the Governors and State Legislatures. For the record, both the CBO and Senate Democrats last year acknowledged that the Obama/Pelosi PPACA was in violation of the Unfunded Mandates Act... and then Senate Democrats voted to simply ignore the UMA. Now, the Obama/Pelosi PPACA's unfunded mandate -- an accounting trick which mades the PPACA seem less expensive by 50% -- is coming back to haunt Senate Democrats.

Think about it: who pays if a state ignores the Obama/Pelosi PPACA, thereby "allowing" the federal government to take action? Ironically, the Justice Department has [perhaps inadvertently] already answered the question in one of its recent briefs.

I'd continue to urge Senate Democrats to swallow their egos, capitulate to the will of The People, and repeal the Obama/Pelosi PPACA in its entirety. To paraphrase Vinson, the unconstitutional Obama/Pelosi PPACA was built as a house of cards and, now that the wind is blowing, the delicacy [flimsiness] of the statute is becoming obvious. As tax data begins to flow and care reports are released by the Democrats currently sequestering them, we'll be able to compare the effects of the Tanning Tax (for example) to CBO estimates: as the cost of the Obama/Pelosi PPACA continues to rise, so will opposition to it... just in time for the next election!

Posted by: rmgregory | February 8, 2011 7:11 PM | Report abuse

Dries,

yes and I'm sure Obama and Sebelius will make sure they lower standards. Sure that'll happen.

SNARK.

For example only 15 states reuqire invitro fertilization. Will the EBP get it?

Posted by: visionbrkr | February 8, 2011 7:23 PM | Report abuse

Perhaps someone can enlighten me, but I cannot see any logic to the several states setting different standards. For one thing, wouldn't it make life easier for insurance companies to have one standard to follow? And haven't Republicans been clamoring for insurance companies to be able to sell policies across state lines? A single federal standard would facilitate that. I'm at a loss to imagine any significant health issue that ought to be covered in one state but not in another.

I guess the only logical reason for state standards I can imagine is that insurers figure they can game the system in states where they have more political clout - Idaho, I'm looking at you.

Posted by: adagio847 | February 8, 2011 8:13 PM | Report abuse

Why does anyone take this journalist seriously?

http://www.nypost.com/p/news/opinion/opedcolumnists/the_fix_was_in_gImIPWyKJdEWhZasJmFIUO

Posted by: vonmiseswasright | February 8, 2011 9:33 PM | Report abuse

Why does anyone take this journalist seriously?

http://www.nypost.com/p/news/opinion/opedcolumnists/the_fix_was_in_gImIPWyKJdEWhZasJmFIUO

Posted by: vonmiseswasright | February 8, 2011 9:34 PM | Report abuse

Let us take an example of Texas. The "Wise Health Insurance" is quite popular in Arizona. It provides so many offers for the low income people.

Posted by: martyqick | February 9, 2011 2:39 AM | Report abuse

Sounds like race to the bottom thinking, unless states are empowered to regulate all insurance sold to their residents, despite being sold across state lines--which sounds a lot like interstate commerce!

Posted by: will12 | February 9, 2011 12:27 PM | Report abuse

@vonmiseswasright:
I won't defend the JournOlist event. Collusion of any sort is not good. EK is a forthright thinker and has interesting and intelligent insights. Something the right wing, generally, lacks.
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But I suppose you're just as upset at the Koch brothers annual GOP retreat right?
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Or SCJ Scalia vacationing with Cheney 2 weeks before he decided on a case involving Cheney?
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Or SCJ Thomas 'forgetting' to disclose his wife's tea party income (or any income at all for that matter)? (he previously did disclose, but then just stopped)
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Or Scalia giving a closed door meeting to Congress? - funny how they won't release what he said.
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2/3's of the government branches colluding in secret doesn't bother you?

Posted by: rpixley220 | February 9, 2011 3:15 PM | Report abuse

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