"Three GOP candidates spend $243M," by Alexander Burns:
"A group of three Republican candidates has spent nearly a quarter-billion dollars on statewide campaigns this cycle, overshadowing even the heavyweight independent groups commonly considered the biggest financial players of the 2010 election.
The trio of Meg Whitman in California, Rick Scott [running for governor against Alex Sink] in Florida and Linda McMahon in Connecticut together has burned through more money than the U.S. Chamber of Commerce, American Crossroads and the American Federation of State, County and Municipal Employees have pledged to spend - combined.
... None ... is ahead in the polls. ... Whitman and McMahon [are] behind."
Sunday, October 24, 2010
IT'S NOT OVER!
Gulf Fishermen Find Miles of Missed Oil
You missed a spot—a big spot. Boating captains in the Gulf of Mexico have spotted massive oil slicks still remaining after this summer’s BP oil spill. Reports document that some of the spills are almost 400 feet wide and at least one mile long. The captains, who stated that they “have been reporting large areas of surface oil in the delta for more than a week,” said there was no response yet on the part of BP or the Coast Guard. This week the waters in the West Bay have calmed down enough so that the weathered orange-colored oil is very visible. Wildlife officials are nervous that the oil will not be removed quickly enough to beat the fall bird migration and prime fishing season. The oil-affected waters are also part of a major shipping throughway and highlight concerns from skeptics who said the clean up reports were vague and overreaching.
Read it at The Times-Picayune
You missed a spot—a big spot. Boating captains in the Gulf of Mexico have spotted massive oil slicks still remaining after this summer’s BP oil spill. Reports document that some of the spills are almost 400 feet wide and at least one mile long. The captains, who stated that they “have been reporting large areas of surface oil in the delta for more than a week,” said there was no response yet on the part of BP or the Coast Guard. This week the waters in the West Bay have calmed down enough so that the weathered orange-colored oil is very visible. Wildlife officials are nervous that the oil will not be removed quickly enough to beat the fall bird migration and prime fishing season. The oil-affected waters are also part of a major shipping throughway and highlight concerns from skeptics who said the clean up reports were vague and overreaching.
Read it at The Times-Picayune
Workers of the World, Watch Out T. M. SHINE
I USUALLY run errands in the afternoon, but one morning last week I was restless and had a craving for Apple Jacks. So I hopped on my bicycle and headed toward the convenience store. For the first few blocks I zigzagged along, enjoying the quiet roads of my sleepy neighborhood. But as I approached the first big intersection, I realized something strange was going on. Cars were jockeying for position, horns blaring; the nose of an Audi came dangerously close to striking my rear tire. The light went red, my feet touched down to stop and steady myself, and as I gazed at the traffic backing up in both directions, I asked myself, “Where on earth are all these people going?”
Then it dawned on me ...work.
Yes, it’s been that long since I was one of them — 432 days to be exact. I’d forgotten about commuter traffic. And that morning, a second epiphany followed the first: I hate people with jobs.
I’m writing to announce that I’ve officially gone beyond the usual job-loss spectrum of denial to acceptance. I’ve hit a more obscure step, No. 8 or 9, in which you to come to grips with the fact that you can’t stand anybody who is employed.
Employed people, with their benefits and direct deposits, seem so smug to me now — bills paid up, money for weekend getaways and nights at the movies. “You didn’t see ‘The Town’ yet?” employed people keep asking me. No, I have no money. I haven’t seen “The Town.” (I have, however, seen “The Great Buck Howard” nine times on Showtime, but no one wants to talk about what a treasure John Malkovich is anymore.)
The problem, I find, is no longer my unemployment. It’s the people with employment — rushing past me on the sidewalk, ties in the wind — who are killing my spirit. I want to start tripping them as they race by, maybe throw an iced coffee in a few of their “out-of-my-way-I’ve-got-to-get-to-my-next-appointment” faces.
I wasn’t always like this. In the beginning, it didn’t seem so bad being unemployed, at least not at this time in history, when so many others are in the same predicament. At first, maybe I was even a little relieved by the rising unemployment rates — 10 percent, 12 percent, even 20 percent in some devastated areas. You see, I’m the kind of guy who never feared the Apocalypse or a nuclear holocaust because I sort of liked the idea of us all going down together. I don’t so much mind being turned into a burning ember or a nuclear shadow on a concrete wall as long as it’s happening to everyone else.
It’s when I’m a shadow on a concrete wall and everyone else is going on a picnic with toasty Quiznos sandwiches that I get upset.
Other things have changed, too. There was a period when I really missed work. One night about six months ago, I went back to the office building where I used to work. I just wanted to be there. I couldn’t go inside (my security code no longer worked), so I climbed a utility ladder attached to the side of the building and strolled along the rooftop until I was standing somewhere above my old desk. I missed it all so much. I missed procrastinating and stealing office supplies. I missed the one co-worker who thought I was funny and, even more so, the one who thought I was attractive. I even missed the guy who used to describe everything as “awesome.”
But that’s all over now. At this point, just walking past the employed on a smoke break is enough to set me off. I try to cover my ears, but I can’t help hearing some guy talk about how he’s going to get the pretty girl in the office to go have Thai food with him, or another guy rehearse the joke he’s cooked up for the afternoon meeting, and then I can’t help wanting to go up to them to say that the pretty girl will go eat Thai with anyone, and that meeting laughs are the easiest laughs in the world.
And the thing of it is, I don’t think I’m part of some lunatic fringe. I am nothing if not representative of the average unemployed worker in America; there are millions of us, and surely others have reached this phase as well.
To be honest, dear reader, my main reason for writing this is to warn you. If you’re ever rushing to a business meeting down a crowded street and you suddenly fall flat on your face, as if somebody tripped you from behind, know this: Somebody did.
T. M. Shine is the author of the novel “Nothing Happens Until It Happens to You.”
Then it dawned on me ...work.
Yes, it’s been that long since I was one of them — 432 days to be exact. I’d forgotten about commuter traffic. And that morning, a second epiphany followed the first: I hate people with jobs.
I’m writing to announce that I’ve officially gone beyond the usual job-loss spectrum of denial to acceptance. I’ve hit a more obscure step, No. 8 or 9, in which you to come to grips with the fact that you can’t stand anybody who is employed.
Employed people, with their benefits and direct deposits, seem so smug to me now — bills paid up, money for weekend getaways and nights at the movies. “You didn’t see ‘The Town’ yet?” employed people keep asking me. No, I have no money. I haven’t seen “The Town.” (I have, however, seen “The Great Buck Howard” nine times on Showtime, but no one wants to talk about what a treasure John Malkovich is anymore.)
The problem, I find, is no longer my unemployment. It’s the people with employment — rushing past me on the sidewalk, ties in the wind — who are killing my spirit. I want to start tripping them as they race by, maybe throw an iced coffee in a few of their “out-of-my-way-I’ve-got-to-get-to-my-next-appointment” faces.
I wasn’t always like this. In the beginning, it didn’t seem so bad being unemployed, at least not at this time in history, when so many others are in the same predicament. At first, maybe I was even a little relieved by the rising unemployment rates — 10 percent, 12 percent, even 20 percent in some devastated areas. You see, I’m the kind of guy who never feared the Apocalypse or a nuclear holocaust because I sort of liked the idea of us all going down together. I don’t so much mind being turned into a burning ember or a nuclear shadow on a concrete wall as long as it’s happening to everyone else.
It’s when I’m a shadow on a concrete wall and everyone else is going on a picnic with toasty Quiznos sandwiches that I get upset.
Other things have changed, too. There was a period when I really missed work. One night about six months ago, I went back to the office building where I used to work. I just wanted to be there. I couldn’t go inside (my security code no longer worked), so I climbed a utility ladder attached to the side of the building and strolled along the rooftop until I was standing somewhere above my old desk. I missed it all so much. I missed procrastinating and stealing office supplies. I missed the one co-worker who thought I was funny and, even more so, the one who thought I was attractive. I even missed the guy who used to describe everything as “awesome.”
But that’s all over now. At this point, just walking past the employed on a smoke break is enough to set me off. I try to cover my ears, but I can’t help hearing some guy talk about how he’s going to get the pretty girl in the office to go have Thai food with him, or another guy rehearse the joke he’s cooked up for the afternoon meeting, and then I can’t help wanting to go up to them to say that the pretty girl will go eat Thai with anyone, and that meeting laughs are the easiest laughs in the world.
And the thing of it is, I don’t think I’m part of some lunatic fringe. I am nothing if not representative of the average unemployed worker in America; there are millions of us, and surely others have reached this phase as well.
To be honest, dear reader, my main reason for writing this is to warn you. If you’re ever rushing to a business meeting down a crowded street and you suddenly fall flat on your face, as if somebody tripped you from behind, know this: Somebody did.
T. M. Shine is the author of the novel “Nothing Happens Until It Happens to You.”
Supremely Bad Judgment MAUREEN DOWD
In the wacky coda to one of the most searing chapters in American history, everyone remained true to form.
Anita Hill reacted with starchy disgust.
Ginni Thomas came across like a spiritually addled nut.
Clarence Thomas was mute, no doubt privately raging about the trouble women have caused him.
And now into the circus comes Lillian McEwen, an old girlfriend of Thomas’s.
Looking to shop a memoir, the 65-year-old McEwen used the occasion of Ginni’s weird phone message to Anita — asking her to “consider an apology” and “pray about this” and “O.K., have a good day!” — to open up to reporters.
If “the real Clarence” had been revealed at the time, he probably wouldn’t have ascended to the court, McEwen told The Times’s Ashley Parker. Especially since the real Clarence denied ever using the “grotesque” argot of the porn movies he regularly rented at a D.C. video store.
In her interviews, McEwen confirmed Thomas’s obsession with women with “huge, huge breasts,” with scouting the women he worked with as possible partners, and with talking about porn at work — while he was head of the federal agency that polices sexual harassment.
Years later, some of the Democrats on that all-male, all-white Senate Judiciary Committee told me they assumed there must have been a consensual romance between the boss and his subordinate. McEwen assumed so, too, because Clarence took Anita with him when he changed agencies. Hill has made it clear she felt no reciprocal attraction.
Joe Biden, the senator who ran those hearings, was leery of the liberal groups eager to use Hill as a pawn to checkmate Thomas. He circumscribed the testimony of women who could have corroborated Hill’s unappetizing portrait of a power-abusing predator.
For the written record, Biden allowed negative accounts only from women who had worked with Thomas. He also ruled out testimony from women who simply had personal relationships with Thomas, and did not respond to a note from McEwen — a former assistant U.S. attorney who had once worked as a counsel for Biden’s committee — reminding him of her long relationship with Thomas.
It’s too late to relitigate the shameful Thomas-Hill hearings. We’re stuck with a justice-for-life who lied his way onto the bench with the help of bullying Republicans and cowed Democrats.
We don’t know why Ginni Thomas, who was once in the thrall of a cultish self-help group called Lifespring, made that odd call to Hill at 7:30 on a Saturday morning. But we do know that the Thomases show supremely bad judgment. Mrs. Thomas, a queen of the Tea Party, is the founder of a new nonprofit group, Liberty Central, which she boasts will be bigger than the Tea Party. She sports and sells those foam Statue of Liberty-style crowns as she makes her case against the “tyranny” of President Obama and Congressional Democrats, who, she charges, are hurting the “core founding principles” of America.
As The Times’s Jackie Calmes wrote, Mrs. Thomas started her nonprofit in late 2009 with two gifts of $500,000 and $50,000, and additional sums this year that we don’t know about yet. She does not have to disclose the donors, whose money makes possible the compensation she brings into the Thomas household.
There is no way to tell if her donors have cases before the Supreme Court or whether her husband knows their identities. And she never would have to disclose them if her husband had his way.
The 5-to-4 Citizens United decision last January gave corporations, foreign contributors, unions, Big Energy, Big Oil and superrich conservatives a green light to surreptitiously funnel in as much money as they want, whenever they want to elect or unelect candidates. As if that weren’t enough to breed corruption, Thomas was the only justice — in a rare case of detaching his hip from Antonin Scalia’s — to write a separate opinion calling for an end to donor disclosures.
In Bush v. Gore, the Supreme Court chose the Republican president. In Citizens United, the court may return Republicans to control of Congress. So much for conservatives’ professed disdain of judicial activism. And so much for the public’s long-held trust in the impartiality of the nation’s highest court.
Justice Stephen Breyer recently rejected the image of the high court as “nine junior varsity politicians.” But it’s even worse than that. The court has gone beyond mere politicization. Its liberals are moderate and reasonable, while the conservatives are dug in, guzzling Tea.
Thomas and Scalia have flouted ethics rules by attending seminars sponsored by Koch Industries, an energy and manufacturing conglomerate run by billionaire brothers that has donated more than $100 million to far-right causes.
Christine O’Donnell may not believe in the separation of church and state, but the Supreme Court does not believe in the separation of powers.
O.K., have a good day!
Anita Hill reacted with starchy disgust.
Ginni Thomas came across like a spiritually addled nut.
Clarence Thomas was mute, no doubt privately raging about the trouble women have caused him.
And now into the circus comes Lillian McEwen, an old girlfriend of Thomas’s.
Looking to shop a memoir, the 65-year-old McEwen used the occasion of Ginni’s weird phone message to Anita — asking her to “consider an apology” and “pray about this” and “O.K., have a good day!” — to open up to reporters.
If “the real Clarence” had been revealed at the time, he probably wouldn’t have ascended to the court, McEwen told The Times’s Ashley Parker. Especially since the real Clarence denied ever using the “grotesque” argot of the porn movies he regularly rented at a D.C. video store.
In her interviews, McEwen confirmed Thomas’s obsession with women with “huge, huge breasts,” with scouting the women he worked with as possible partners, and with talking about porn at work — while he was head of the federal agency that polices sexual harassment.
Years later, some of the Democrats on that all-male, all-white Senate Judiciary Committee told me they assumed there must have been a consensual romance between the boss and his subordinate. McEwen assumed so, too, because Clarence took Anita with him when he changed agencies. Hill has made it clear she felt no reciprocal attraction.
Joe Biden, the senator who ran those hearings, was leery of the liberal groups eager to use Hill as a pawn to checkmate Thomas. He circumscribed the testimony of women who could have corroborated Hill’s unappetizing portrait of a power-abusing predator.
For the written record, Biden allowed negative accounts only from women who had worked with Thomas. He also ruled out testimony from women who simply had personal relationships with Thomas, and did not respond to a note from McEwen — a former assistant U.S. attorney who had once worked as a counsel for Biden’s committee — reminding him of her long relationship with Thomas.
It’s too late to relitigate the shameful Thomas-Hill hearings. We’re stuck with a justice-for-life who lied his way onto the bench with the help of bullying Republicans and cowed Democrats.
We don’t know why Ginni Thomas, who was once in the thrall of a cultish self-help group called Lifespring, made that odd call to Hill at 7:30 on a Saturday morning. But we do know that the Thomases show supremely bad judgment. Mrs. Thomas, a queen of the Tea Party, is the founder of a new nonprofit group, Liberty Central, which she boasts will be bigger than the Tea Party. She sports and sells those foam Statue of Liberty-style crowns as she makes her case against the “tyranny” of President Obama and Congressional Democrats, who, she charges, are hurting the “core founding principles” of America.
As The Times’s Jackie Calmes wrote, Mrs. Thomas started her nonprofit in late 2009 with two gifts of $500,000 and $50,000, and additional sums this year that we don’t know about yet. She does not have to disclose the donors, whose money makes possible the compensation she brings into the Thomas household.
There is no way to tell if her donors have cases before the Supreme Court or whether her husband knows their identities. And she never would have to disclose them if her husband had his way.
The 5-to-4 Citizens United decision last January gave corporations, foreign contributors, unions, Big Energy, Big Oil and superrich conservatives a green light to surreptitiously funnel in as much money as they want, whenever they want to elect or unelect candidates. As if that weren’t enough to breed corruption, Thomas was the only justice — in a rare case of detaching his hip from Antonin Scalia’s — to write a separate opinion calling for an end to donor disclosures.
In Bush v. Gore, the Supreme Court chose the Republican president. In Citizens United, the court may return Republicans to control of Congress. So much for conservatives’ professed disdain of judicial activism. And so much for the public’s long-held trust in the impartiality of the nation’s highest court.
Justice Stephen Breyer recently rejected the image of the high court as “nine junior varsity politicians.” But it’s even worse than that. The court has gone beyond mere politicization. Its liberals are moderate and reasonable, while the conservatives are dug in, guzzling Tea.
Thomas and Scalia have flouted ethics rules by attending seminars sponsored by Koch Industries, an energy and manufacturing conglomerate run by billionaire brothers that has donated more than $100 million to far-right causes.
Christine O’Donnell may not believe in the separation of church and state, but the Supreme Court does not believe in the separation of powers.
O.K., have a good day!
Health Care Overhaul Depends on States’ Insurance Exchanges
WASHINGTON — In Massachusetts, which has had a government-run health insurance marketplace for four years, people typically file paper applications for subsidized coverage offered by one of five state-approved insurers.
In Utah, employees of small businesses can go to a state Web site and sign up for insurance over the Internet, almost as easily as they download music from iTunes.
The success of President Obama’s health care overhaul, with its promise of affordable coverage for all, depends on the creation of such retail shopping malls, known as health insurance exchanges.
Massachusetts and Utah provide a glimpse of the future, and they offer radically different models for other states. The battle over health care is shifting to the states, and the design of insurance exchanges will be one of the most pressing issues for state legislators when they convene early next year.
“Utah and Massachusetts may well serve as bookends for other states,” said Norman K. Thurston, the policy coordinator at the Utah Health Department.
The Congressional Budget Office predicts that by 2019, about 24 million people will have insurance through exchanges, with four-fifths of them getting federal subsidies that average $6,000 a year per person. People with incomes up to four times the poverty level (about $88,000 a year for a family of four) will be eligible for subsidies.
The Utah Health Exchange organizes the market, allowing consumers to compare a wide variety of health plans sold by any insurers that want to participate.
In the Massachusetts exchange, known as the Connector, the state serves as an active purchaser, soliciting bids from insurance companies and negotiating prices and benefits in an effort to secure the best value for state residents. Health plans cannot be sold through the Connector unless they receive its seal of approval.
“Massachusetts has been more selective and aggressive in contracting,” said Jon M. Kingsdale, who was executive director of the Massachusetts exchange from its creation in 2006 until June of this year.
Matthew A. Spencer, manager of the Utah exchange, said: “We are on the other end of the spectrum from Massachusetts. Our exchange is wide open for any carrier that wants to participate. We define the minimum benefits that plans need to offer. But we step back and allow carriers to compete within the exchange, setting their own prices.”
The idea of an insurance exchange has bipartisan appeal.
Liberals and conservatives alike see it as a way to concentrate the purchasing power of individuals and small businesses.
The federal law was shaped, to a large degree, by the experience of Massachusetts. But Senator Orrin G. Hatch, Republican of Utah, said: “Utah is not Massachusetts. Nor does it want to be.”
Other states will probably fall somewhere along the continuum from Boston to Salt Lake City as they try to figure out the right mix of regulation and competition.
State legislators are asking: Can we get a better deal by limiting competition in the exchange or by accepting all qualified health plans? Should states negotiate premiums or rely on market forces to set rates?
David Clark, a Republican who is speaker of the Utah House of Representatives, said: “In our exchange, the government is a market facilitator, not a contracting agent. We believe in the invisible hand of the marketplace rather than the heavy hand of government.”
Utah has no interest in putting its exchange plans out for bid, Mr. Thurston said. “Any attempt to standardize benefit designs tends to discourage competition and entry into the market, and limits choice,” he said.
In Massachusetts, State Senator Richard T. Moore, a Democrat who is president of the National Conference of State Legislatures, said: “We took a much more governmental approach. But both models make sense. Small states might find Utah is a good model. Bigger industrialized states might go the route we went.”
Massachusetts officials point to the state’s near-universal coverage as evidence that their approach is working. The Census Bureau says 95.6 percent of Massachusetts residents were covered by health insurance last year, compared with 83.3 percent for the nation as a whole and 85.2 percent for Utah.
“We have the lowest uninsured rate in the nation, and we are immensely proud of that,” said Glen Shor, executive director of the Massachusetts Connector.
The White House has provided $49 million to states to help them set up exchanges, which are envisioned as a kind of bazaar where insurers will offer their products side by side, so consumers and employers can make intelligent comparisons.
Congress assumed that insurance would also be sold outside the exchange. But federal subsidies, to help pay for insurance, will be available only to people who enroll in health plans through an exchange.
Exchanges will also play a crucial role as gateways to Medicaid and other public health programs. If people are found eligible, the exchange will help them enroll. In Massachusetts, the same application form is used for Medicaid and for subsidized private insurance purchased through the Connector.
California is another pioneer. On Sept. 30, Gov. Arnold Schwarzenegger, a Republican, signed two bills establishing the California Health Benefit Exchange, with broad powers to “negotiate on behalf of the public” and select qualified health plans.
The legislation generated intense lobbying, and the governor’s intentions were unclear until the last minute. Mr. Obama had urged him to sign the bills and was thrilled when he did, aides said.
The fight in Sacramento offers a preview of what other states can expect. In a letter to California lawmakers in August, Natalie Cárdenas, regional director of government relations for Anthem Blue Cross, a unit of WellPoint, complained that the exchange would have the power to pick winners and losers in the insurance market.
“Federal law will already limit the types of products that carriers can offer,” Ms. Cárdenas said. “Beyond that, the marketplace should determine what products consumers and small employers can purchase, not a government bureaucracy.”
The California Chamber of Commerce urged a veto of the bills, saying they “could lead to unnecessary cost increases and limited choice for employers.”
But Betsy M. Imholz, a lobbyist for Consumers Union, said the California laws struck the right balance.
“At first,” Ms. Imholz said, “the exchange may want to have a large number of health plans participating. But then the state needs to winnow down the number so consumers can see where they will get the best value.”
The California law says the exchange should choose health plans that “offer the optimal combination of choice, value, quality and service.”
Massachusetts requires people to have insurance. Utah does not.
Massachusetts provides more generous subsidies. But, Mr. Kingsdale said, the biggest difference is the magnitude of the two state programs.
In Massachusetts, more than 154,000 people receive subsidized coverage through the exchange, and 40,000 receive unsubsidized coverage, which can be bought on the Web. The Utah exchange, created under a 2008 state law, began enrollment this year. About 1,200 people have coverage through the Utah exchange, and the number is expected to grow to 10,000 by July 2011.
“We anticipate exponential growth,” Mr. Spencer said.
Under the new federal law, the exchanges must be in operation by January 2014. Federal officials will assess states’ progress as of Jan. 1, 2013, and will run the exchange in any state that is unable or unwilling to do so.
The exchanges will have a huge number of duties. They must evaluate health insurance plans and publish “standardized comparative information.” They must set up telephone call centers to answer consumers’ questions. They must determine who is eligible for subsidies and who will be exempt from the penalties imposed on people who go without insurance. They must build new computer systems to exchange data with state Medicaid agencies, insurance companies, employers and federal agencies.
While the exchange cannot explicitly control prices, it can exclude health plans that show a pattern of “excessive or unjustified premium increases.”
State officials worry that sick people will gravitate to the exchange, while healthier people who do not need subsidies will buy insurance outside it. However, insurers must agree to charge the same prices inside or outside the exchange.
Moreover, the law stipulates that members of Congress must get their health insurance through an exchange. So lawmakers will presumably be alert to problems.
NY TIMES By ROBERT PEAR
In Utah, employees of small businesses can go to a state Web site and sign up for insurance over the Internet, almost as easily as they download music from iTunes.
The success of President Obama’s health care overhaul, with its promise of affordable coverage for all, depends on the creation of such retail shopping malls, known as health insurance exchanges.
Massachusetts and Utah provide a glimpse of the future, and they offer radically different models for other states. The battle over health care is shifting to the states, and the design of insurance exchanges will be one of the most pressing issues for state legislators when they convene early next year.
“Utah and Massachusetts may well serve as bookends for other states,” said Norman K. Thurston, the policy coordinator at the Utah Health Department.
The Congressional Budget Office predicts that by 2019, about 24 million people will have insurance through exchanges, with four-fifths of them getting federal subsidies that average $6,000 a year per person. People with incomes up to four times the poverty level (about $88,000 a year for a family of four) will be eligible for subsidies.
The Utah Health Exchange organizes the market, allowing consumers to compare a wide variety of health plans sold by any insurers that want to participate.
In the Massachusetts exchange, known as the Connector, the state serves as an active purchaser, soliciting bids from insurance companies and negotiating prices and benefits in an effort to secure the best value for state residents. Health plans cannot be sold through the Connector unless they receive its seal of approval.
“Massachusetts has been more selective and aggressive in contracting,” said Jon M. Kingsdale, who was executive director of the Massachusetts exchange from its creation in 2006 until June of this year.
Matthew A. Spencer, manager of the Utah exchange, said: “We are on the other end of the spectrum from Massachusetts. Our exchange is wide open for any carrier that wants to participate. We define the minimum benefits that plans need to offer. But we step back and allow carriers to compete within the exchange, setting their own prices.”
The idea of an insurance exchange has bipartisan appeal.
Liberals and conservatives alike see it as a way to concentrate the purchasing power of individuals and small businesses.
The federal law was shaped, to a large degree, by the experience of Massachusetts. But Senator Orrin G. Hatch, Republican of Utah, said: “Utah is not Massachusetts. Nor does it want to be.”
Other states will probably fall somewhere along the continuum from Boston to Salt Lake City as they try to figure out the right mix of regulation and competition.
State legislators are asking: Can we get a better deal by limiting competition in the exchange or by accepting all qualified health plans? Should states negotiate premiums or rely on market forces to set rates?
David Clark, a Republican who is speaker of the Utah House of Representatives, said: “In our exchange, the government is a market facilitator, not a contracting agent. We believe in the invisible hand of the marketplace rather than the heavy hand of government.”
Utah has no interest in putting its exchange plans out for bid, Mr. Thurston said. “Any attempt to standardize benefit designs tends to discourage competition and entry into the market, and limits choice,” he said.
In Massachusetts, State Senator Richard T. Moore, a Democrat who is president of the National Conference of State Legislatures, said: “We took a much more governmental approach. But both models make sense. Small states might find Utah is a good model. Bigger industrialized states might go the route we went.”
Massachusetts officials point to the state’s near-universal coverage as evidence that their approach is working. The Census Bureau says 95.6 percent of Massachusetts residents were covered by health insurance last year, compared with 83.3 percent for the nation as a whole and 85.2 percent for Utah.
“We have the lowest uninsured rate in the nation, and we are immensely proud of that,” said Glen Shor, executive director of the Massachusetts Connector.
The White House has provided $49 million to states to help them set up exchanges, which are envisioned as a kind of bazaar where insurers will offer their products side by side, so consumers and employers can make intelligent comparisons.
Congress assumed that insurance would also be sold outside the exchange. But federal subsidies, to help pay for insurance, will be available only to people who enroll in health plans through an exchange.
Exchanges will also play a crucial role as gateways to Medicaid and other public health programs. If people are found eligible, the exchange will help them enroll. In Massachusetts, the same application form is used for Medicaid and for subsidized private insurance purchased through the Connector.
California is another pioneer. On Sept. 30, Gov. Arnold Schwarzenegger, a Republican, signed two bills establishing the California Health Benefit Exchange, with broad powers to “negotiate on behalf of the public” and select qualified health plans.
The legislation generated intense lobbying, and the governor’s intentions were unclear until the last minute. Mr. Obama had urged him to sign the bills and was thrilled when he did, aides said.
The fight in Sacramento offers a preview of what other states can expect. In a letter to California lawmakers in August, Natalie Cárdenas, regional director of government relations for Anthem Blue Cross, a unit of WellPoint, complained that the exchange would have the power to pick winners and losers in the insurance market.
“Federal law will already limit the types of products that carriers can offer,” Ms. Cárdenas said. “Beyond that, the marketplace should determine what products consumers and small employers can purchase, not a government bureaucracy.”
The California Chamber of Commerce urged a veto of the bills, saying they “could lead to unnecessary cost increases and limited choice for employers.”
But Betsy M. Imholz, a lobbyist for Consumers Union, said the California laws struck the right balance.
“At first,” Ms. Imholz said, “the exchange may want to have a large number of health plans participating. But then the state needs to winnow down the number so consumers can see where they will get the best value.”
The California law says the exchange should choose health plans that “offer the optimal combination of choice, value, quality and service.”
Massachusetts requires people to have insurance. Utah does not.
Massachusetts provides more generous subsidies. But, Mr. Kingsdale said, the biggest difference is the magnitude of the two state programs.
In Massachusetts, more than 154,000 people receive subsidized coverage through the exchange, and 40,000 receive unsubsidized coverage, which can be bought on the Web. The Utah exchange, created under a 2008 state law, began enrollment this year. About 1,200 people have coverage through the Utah exchange, and the number is expected to grow to 10,000 by July 2011.
“We anticipate exponential growth,” Mr. Spencer said.
Under the new federal law, the exchanges must be in operation by January 2014. Federal officials will assess states’ progress as of Jan. 1, 2013, and will run the exchange in any state that is unable or unwilling to do so.
The exchanges will have a huge number of duties. They must evaluate health insurance plans and publish “standardized comparative information.” They must set up telephone call centers to answer consumers’ questions. They must determine who is eligible for subsidies and who will be exempt from the penalties imposed on people who go without insurance. They must build new computer systems to exchange data with state Medicaid agencies, insurance companies, employers and federal agencies.
While the exchange cannot explicitly control prices, it can exclude health plans that show a pattern of “excessive or unjustified premium increases.”
State officials worry that sick people will gravitate to the exchange, while healthier people who do not need subsidies will buy insurance outside it. However, insurers must agree to charge the same prices inside or outside the exchange.
Moreover, the law stipulates that members of Congress must get their health insurance through an exchange. So lawmakers will presumably be alert to problems.
NY TIMES By ROBERT PEAR
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