Federal health exchange likely best for Arizona

A decision by Arizona Gov. Jan Brewer to forgo having our state government establish its own health insurance exchange under the Affordable Care Act is drawing mixed reactions.

The exchanges are one of the requirements of the law, also known as Obamacare, and are intended to provide a place where consumers can go to find private insurers who will be providing coverage under the national health care plan.

There are three options for the exchanges, which must be in place by 2014 when Obamacare is fully implemented: states can operate their own exchanges under federal rules, multiple states can join together to provide a regional exchange, or if neither of those happens then the federal government will put in place its own exchange for the state.

Gov. Brewer has decided to let the federal government operate the exchange, saying there would be little actual local control since states have to operate their exchanges under federal rules. She also cited a lack of clarity at this point about the rules for them and her belief that state operation of the exchange would be costly.

Some are questioning her decision. Democratic leaders in the Arizona House say her decision removes any possible local influence on exchange decisions regarding insurers.

But the Republican president-elect of the Arizona Senate, Andy Biggs, supported the governor, saying “any exchange run by Arizona would still include an inappropriate imposition by the federal government on our state.”

The reasoning of the governor and her supporters on this issue seems ironic, given their opposition to Obamacare because it takes away a local role in health care. It does not make sense, then, to forgo the only real opportunity to have at least some local influence, even if it is limited.

But in the end, we think it is good for Arizona to have a federally run exchange.

The reality is that this is a national health care program, not a state one. As such, it is more efficient to have a uniform insurance exchange operated by the federal government rather than a bunch of state ones. We have long doubted the real practicality of having each state operate its own exchange when it would be more efficient, and perhaps cost effective, to have one overall exchange.

A number of other states have been taking the same path as Brewer, so in the end it may end up being a largely federal exchange after all.