If you read the news lately  you might think that Sen. Phil Berger has taken the approach of South Carolina or Louisiana in rejecting a state-based health benefits exchange. As a reminder, an exchange is an organization that will allow individuals to shop for insurance in a standardized, understandable way and purchase policies at group rates. Each state can set up its own exchange, have the federal government set up an exchange on its behalf, or establish a partnership exchange between the feds and the state.
As another reminder, the NC Institute of Medicine convened meetings among stakeholders of every stripe to discuss how an exchange should be structured. That group came to a general consensus about legislation where everyone got something but no one got everything they wanted.
Blue Cross and Blue Shield of North Carolina  had its friends (Reps. Brubaker and Dockham) ignore the IOM recommendations and file a bill that gave the state’s largest insurer everything it wanted. (The North Carolina Medical Society also had some input on the bill.) The House moved the legislation along despite objections from a wide range of organizations that the bill was fatally flawed and probably not compliant with federal regulations.
Then this clunker landed in the Senate. The Senate took a short look and many folks concluded that this thing needed a serious overhaul. But with budget writing and other priorities there was not much time to fix the broken bill sent from the House. So Berger wisely took a pass.
The situation was similar in the short session. Remaking the legislation was a steep climb and then there was a looming Supreme Court decision that could have scrapped any effort the Senate exerted by throwing out the Affordable Care Act. Again the Senate took a pass and again it was a reasonable thing to do.
So here we are. While it’s true that it would be extraordinarily difficult to get things up and going by 2014 — and the state has to pass a spot check by the feds in January — we can still have a state-based exchange. It may be that the feds run parts of our exchange in 2014 and the state takes over the entire operation in 2015. To some people that may sound like a federal takeover of our exchange. To me it sounds like semantics. In a few years North Carolina will likely have its own exchange operated by the state.
And if it takes a few years to get a state-based exchange don’t blame the Senate. The House could have passed a bill based on the NC Institute of Medicine recommendations within a few weeks and with nearly universal approval and praise. Instead they (Republicans and Democrats) allowed a few powerful interest groups to kill the entire enterprise.
We will get another shot at this. We still have the consensus recommendations. Let’s get those negotiated provisions enacted into law and move on.