Mandates: The decision before the decision

October 5, 2012 by  

Lobbying money is flowing freely at the Capitol these days to convince Arizona legislators to implement the core provision of Obamacare  in Arizona:  a state-run Health Insurance Exchange – through which hundreds of millions in subsidies will flow from Washington to insurers participating in the exchange – as well as other key information – like tax, personal health & employment information – etc.

The Governor seems intent on implementing one, and has already applied for a $30 million planning grant to do just that – but  so far most Republican legislators in the state have balked at legislation required to fund it.  In fact, Sen. Pierce sent members a letter by U.S. Senator Orrin Hatch pressing HHS for more transparency & detail without which states would be foolish to make a decision to fund and run a huge new bureaucracy.

However....most legislators had no idea another key decision was made this week by the Governor: mandating the kind of health insurance citizens will be forced to purchase  under the law.    Here’s what I communicated to fellow legislators following the Governor’s action – which obviously flew deep under the radar:  

TO:                           House & Senate Majority Members

FROM:                    Senator Nancy Barto

DATE:                     October 2, 2012

SUBJECT:             PPACA (Obamacare) update

As many of you know, implementation of the Patient Protection and Affordable Care Act (PPACA) has been in effect for some time now, even prior to the Supreme Court Decision upholding the individual mandate.  Most recently, Governor Brewer moved one step closer to solidifying Obamacare for Arizona by submitting an essential health benefits plan to the Secretary of Health and Human Services.  This is a key component of the PPACA, as it dictates the marketplace on cost and coverage for health care for all of our citizens.  This is indeed a very disappointing development.

Arizona should maintain its strong opposition to Obamacare by joining other states that have declined participation in any health insurance exchange activities.  The selection of a single health benefits package that imposes mandates on the public, increases costs and falls short on affordability should not be a legacy worthy of Arizona.  The rules and guidelines relating to the health benefits are not even complete.  Answers to questions regarding coverage are not there to make an informed decision.  The only certainty we have been apprised of is that premium costs will go up – and will rise even more once guaranteed issue, community rating and additional mandates are factored into the cost of insurance.

I would propose that we not collude with the Federal government on creating an exchange. I don’t believe we have an obligation to build the foundation to a program that is fundamentally flawed and goes against free market principles and infringes on our state’s rights.  By doing so we assume responsibility for the shortcomings this law holds and are bound to take action on behalf of Arizonans in perpetuity.  This is not our idea.  It should not be our handiwork.

Furthermore, the selection of an essential health benefit is only temporary.  It will be in place only through 2014-2015, after which an entirely different benefits mandate process may be imposed.  So while we may believe we are averting policies that pay for voluntary abortions, provide greater behavioral health coverage, and offers greater developmental disability services, the Federal government can uniformly change these policies.  This is a false choice and we should be wary of doing the Federal government’s bidding.  It is an illusion to believe that we will have greater oversight if we manage a state-run exchange.  The mere fact that this essential health benefit is temporary is a clear indication.

Please join me in expressing your concern regarding Governor Brewer’s decision to move ahead with implementation of the Affordable Care Act.    It is indeed the federalism debate of our generation and we should side with Arizona.


Senator Nancy Barto




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