Overhauling the United States health care system will be complicated and take time. It will rightfully involve feedback and questions from the states and assistance and flexibility from the federal government.
But having questions about the law should not deter states from cooperating with the implementation of the Affordable Care Act. Questions should be part of the process, not an excuse to wait until the next election with the hope of overturning the law then.
The Republican Governors Association sent a letter to the Obama administration last week seeking answers to many questions about the Medicaid expansion provision of the law and the required health insurance exchanges, which act as an online marketplace for people to shop for private insurance plans.
The letter was beneficial in the sense that it opened discussion about realistic concerns, instead of relying on common rhetoric about the law making Americans less free. Governors asked the federal government to explain how long-term funding of health care exchanges will be sustained and wanted to know the deadline by which states have to say whether they will participate in the Medicaid expansion.
The Republican governors asked what regulations will have to be reopened for public comment in regard to the health care exchanges. Also, when will the federal government provide guidance about health benefits required under the exchanges? How will the states be reimbursed through Medicaid for medical services provided to undocumented aliens?
Governors have an especially large number of questions concerning the expansion of their Medicaid programs — since the Supreme Court ruling allows the states to opt out of the Medicaid expansion without affecting current funding. Not all Democrats attending the National Governors Association meeting last weekend were committed to expanding Medicaid, while not all Republicans were ruling it out.
Gov. Paul LePage has said he will not make recommendations to the Maine Legislature until after he has answers to his questions and until after the November election — though he has expressed doubt several times about expanding Medicaid and building a health insurance exchange.
Though the law says the federal government will cover the entire cost of expanding Medicaid for the first three years and then 90 percent of the cost after that, some governors have said they want more assurance that federal officials will not pull the funding. Others have asked for more flexibility in running Medicaid.
But governors can’t have it both ways and claim they don’t have enough decision-making power while asking for more direction from the federal government. That’s what LePage did in his radio address on Saturday. He asked for more state flexibility and also expressed frustration about the federal government not providing enough guidance to states about running the health insurance exchanges.
States will need to have a little patience, while it’s up to the federal government to provide clear answers to the governors to help them prepare. Mainers may keep in mind that a similar process has happened before — with the enactment of Medicaid in 1965. It took years for each state to sign up, with Arizona the last one in 1982.
We hope it’s not too much to ask that Maine not delay for 17 years before getting on board with the Affordable Care Act. Let the questions be part of the process of implementing the law, not tearing it down.