A national health care exchange . . . by default

The following is based on information from an article in Politico.

The original Affordable Care Act had some important features which contributed importantly to its predicted success:   (1)  The expansion of Medicaid with penalties for the states that did not comply;   and (2)  The expectation that each state would set up its own insurance market exchange.

The U. S. Supreme Court struck down #1 and made the Medicaid expansion voluntary for each state with no penalty.   Recalcitrant Republican governors and legislators have balked at that, as well as #2.   It's amazing that the ACA has done as well as it has without either of these components.

As of now, 36 of the 50 states rely on the federal HealthCare.gov rather than setting up their own exchange.   Designed to be a limited fallback alternate for states that had difficulty setting up their own exchange -- it was then overwhelmed when it had to handle the volume of 36 states at once.

Republicans of course are whining about the centralized control:   Rep. Tom Price (R-GA, regretably my own congressman) says that "This was predictable. . . .  Our friends on the other side didn't listen."

Hold up there, Dr. Price.   President Obama and the Democrats in Congress tried to give the states autonomy to design their own exchanges -- and two-thirds of them wouldn't take it.   They just didn't want to play in Obama's sandpile, so they said "No."

But, don't you Republicans see what you did, by having the states refuse?   YOU actually mandated that we have a national exchange by default.    And it's not "national health insurance."  It's a national marketplace, for god's sake.   Doesn't that word ring familiar bells for all you market-based conservatives?

A few, like Sen. Orrin Hatch (R-UT), the leading Republican on the Senate Finance Committee, are beginning to want an investigation -- not into HealthCare.gov but into why the states failed to set up their own.   Better late than never.

Well, not really.   Because the best thing, IMHO, would be to go directly to a single-payer, national health service.   But conservatives are so opposed to anything that has even a whiff of "socialism," that they would probably even give in and set up state exchanges to stall that off.

The undeniable fact, however, is that they can't have it both ways.

Ralph