I understand why Governor Deal, his administration, and other Republican-controlled state governments delayed preparations to comply with the Affordable Care Act/Obamacare.

But, after the Supreme Court upheld the vast majority of the law, there were plenty of reasons to assume that the ACA — or the vast majority of it — would still go into effect even under a Romney presidency:

  • Even if one discounted the presidential polling, it has looked unlikely for months that Republicans would gain control of the Senate, and it was never realistic for them to establish a 60 vote majority in that chamber.
  • Of the major components of Obamacare, the individual mandate is the only one that polls badly with the American people. And the mandate really isn’t a mandate, since taxpayers can just pay a higher tax if they choose to remain uninsured.
  • Some of the other components of Obamacare are highly popular, like parents being able to keep children on their plans till age 26, and would be hard to overturn even if there had been a Republican landslide.
  • Obamacare is at heart a Republican plan, even if many have now rebuke it. Mitt Romney instituted a very similar plan in Massachusetts. Given his policy shifting over the decades, did anyone think Romney was really serious about totally throwing Obamacare out and starting all over with some new undefined plan?

By delaying their preparations, states like Georgia put themselves in a bind. The ACA is going into effect, and states need to play catch up if they want to make the law work as well as possible for their citizens.

Yesterday, Governor Deal, citing too many restrictions in how the states can run their own insurance exchanges, ceded power to the federal government to establish and operate the online insurance exchange from which uninsured Georgians will choose their coverage (or not).

So because the state can’t have enough control, we’ve opted not to have any control.

From the AJC’s Georgia cedes control of health insurance exchange to feds:

The exchanges are a pillar of the landmark law that aims to provide millions of uninsured Americans with health coverage. They are online marketplaces where consumers and small businesses will be able to compare the quality and prices of health plans. An estimated 900,000 Georgians are expected to shop on the exchange website — where people will also be able to find out if they are eligible for Medicaid, the government health program for the poor, or federal subsidies designed to make coverage affordable.

Industry observers say a state-created exchange would have been able to respond more quickly to market forces unique to Georgia.

The state also could have had some flexibility in how an exchange operated, such as who would govern it and how it contracts with health plans, said Tim Sweeney, a health-care policy expert at the nonprofit Georgia Budget and Policy Institute.

While Georgia choosing not to create its own exchange may be a missed opportunity, consumers will still have access to the same options under a federal marketplace, Sweeney added.

“It’s important for people to know that there will still be an exchange here,” he said. “Other provisions of the law will be implemented … this is not opting out of the law.”

Governor Deal is also likely to reject the expansion of Medicaid in the state. That’s a key part of the law, too, but the Supreme Court allowed states to opt out of that. At first, the Medicaid expansion would be 100 percent federally funded, and then funded later at 90 percent (if I have my numbers right). So the state government would have to pay relatively little for the dramatic expansion of insurance to low income Georgians. But if we reject that expansion out of principle, keep in mind that Georgians’ federal taxes will at the same time be supporting Medicaid expansion in other states.

And we already guarantee emergency treatment — very expensive treatment — for low income citizens. The Medicaid expansion would give those same people access to preventive care and other basic services that could pre-empt more costly emergency room visits and, more importantly, improve quality of life.

From the Georgia Budget and Policy Institute’s recent post Expanding Medicaid to cover more Georgians is a great deal for Georgia:

Financially, the expansion is a great deal for Georgia because the federal government will pick up the vast majority of the costs – and the state will spend less on services for Georgians without health insurance, because there will be dramatically fewer people without coverage.

The expansion will also give a boost to Georgia’s economy because the federal money coming in will pay salaries of nurses, doctors and other health care workers all over the state.

Finally, and perhaps most importantly, the expansion will save lives and improve the health and well-being of the Georgians who will get needed health care. Georgians who become newly covered through the Medicaid expansion will be healthier and more financially secure as a result, recently published (and still ongoing) studies show.

I actually feel pretty confident that Georgia will eventually get on board with the Medicaid expansion. If the federally established health care exchange works decently well, we might not opt for a state-run one. But that would be too bad.

Republican leaders who have opposed and continue to oppose Obamacare have two options, as I noted in the comments of a lively conversation at Peach Pundit.

They can keep trying to resist it even though it’s the law of the land. That course will virtually guarantee that the law won’t help citizens as much as it could.

Or they can get in the game, implement the existing law as well as possible, and work from within to change it.

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