The Public Policy

ACORN’s Public Option

Health exchanges will do just as well.

By 9.15.09

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Coming to a neighborhood near you: nonprofit health coops administered by ACORN designed to use state Medicaid programs to usher in single payer health care.

A Tea Party conspiracy theory? Hardly. While the catfight over the cost of reform and the nature of the public plan escalated as details unfolded, no one paid attention to what the harmless sounding exchanges actually do.

Few policy analysts or policymakers have carefully examined the role exchanges will play in expanding government run health care with the help of community organizers (known as "navigators" in the health bills). As American Enterprise Institute health scholar Tom Miller points out: "The national exchange initially was marketed as a means to provide new choices to those largely shut out of the traditional employer-sponsored group health insurance market. But the House bill gives away its ultimate objective by authorizing the Orwellian 'Health Choices' commissioner to open the national exchange to ALL workers, even in large self-insured employer plans, by 2015…. It empowers that commissioner and her forthcoming bureaucracy to fill in most of open-ended opportunities for regulatory commands and controls, over time."

Specifically, Miller notes that health exchanges will be used to limit what Americans can spend on health care each year by deciding what type of benefits they will receive, the plans they can choose from, and how much health plans can charge.

Health exchanges are, in one respect, just another name for the Health Alliances that regulated health plans under the Clinton health proposal. In Clintoncare, as in current proposals, only qualified health plans would be eligible to sell insurance inside an alliance (exchange) and would be required to cover all the benefits a National Health Board (Health Choices Commission) established for a certain amount of money per person.

Exchanges would also have the power to implement premium targets, control the rate of premium increases through regulation, or impose taxes on high-cost health plans consistent with federal regulations.

If that sounds like it would lead to less choice, you are right. Heritage Foundation health scholar Robert Moffitt  observes: "If the President wanted to create a national market for health insurance, he could simply propose the repeal of outdated provisions of federal law that erect barriers to the purchase of health coverage across state lines. The President is obviously not interested in creating anything like a normal national, competitive market for health insurance."

Instead exchanges reduce the number of private health plans by controlling prices and the introduction of new technology. Moreover, exchanges also have significant power to introduce an "all-payer" system if other health care plans are deemed not affordable. The House health bill allows the Health Choice commission to terminate state exchanges that do not meet federal standards of price and benefits. The Baucus bill, by letting the exchange regulate premium rates and benefits levels, paves the way for the steady erosion of private coverage as well.

But that's not all. The Left is already planning to push for exchange-led expansion of a combination of Medicaid and the State Children's Health Insurance Program (SCHIP) to compete directly with health plans. By aggressively cornering the market on "navigation" contracts, these groups seek to lobby for such alternatives at the state level.

None of the current proposals prohibit Medicaid or SCHIP (both have no requirement to screen for illegal immigrants) from participating in state exchanges. States could use both to form their own "public options" or health cooperatives and compete alongside private plans. (Similarly, a decade ago community activists pushed to use Medicaid for SCHIP instead of private health plans.)

Government-run health care could rapidly expand through exchanges. All congressional proposals would add 28 million more Americans to Medicaid. Why create a new public plan for the rest of us when states could use the two existing public options, Medicaid and SCHIP? Why not have "navigators" use them to create health cooperatives?

Best of all, the establishment of and enrollment in these exchange-sponsored public plans would be aided by a familiar nonprofit organization.

Exchanges have to contract with "navigators" -- nonprofit organizations that know health care and know how to enroll hard to reach people. Enter Nets2Ladders, "a powerful, automated benefits enrollment platform" designed to "increase the efficiency and effectiveness of enrolling low-income families in federal and state benefits programs" such as Medicaid and SCHIP. By January 2010, all 50 states will be covered by this platform. And nearly 26 states have contracts with the group that administers the program already.

The organization? ACORN of course. No organization is better suited to be a health exchange "navigator." Which tells you everything you need to know about the real intent and impact of health exchanges.

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About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.