Officials in a dozen states surveyed by POLITICO weren’t eager to embrace opt-outs that would let states skirt key insurance provisions, including safeguards for people with pre-existing conditions and a set of basic, required health benefits.
That reticence is striking given that “state flexibility” has been at the top of the governors’ health care wish lists for years. It shows the political peril of endorsing a concept that could spike premiums and risk coverage for the sick, including some with life-threatening or disabling conditions.
Once the dust settles — assuming the American Health Care Act makes it through the Senate and eventually reaches President Donald Trump’s desk — that could change, particularly in red states that have been most hostile to Obamacare. Should these Obamacare exemptions survive in the Senate version, Arkansas, Florida, Georgia, Kentucky, Texas, Tennessee and Wisconsin are among those seen as the most likely to pursue them. Governors’ spokesmen declined comment in several of those states.
But for now, state officials are holding back. Governors run the risk of being blamed for abandoning patients with pre-existing conditions if they grab any of these exemptions.
“If you are a state or a governor or an insurance commissioner and you want to start doing this … it’s a microcosm of what Congress is experiencing now,” said Christopher Koller, a former insurance commissioner who heads the Milbank Memorial Fund. "There’s a lot of moving parts. You make [insurance] cheaper for younger people, you make it more expensive for older people.”
