Compliance a dicey matter for governors across the nation

A date that seemed a long ways away in 2009, when Obamacare was being debated, is now a deadline that is looming large for Gov. Dave Heineman and every other governor in the nation. Nov 16, 2012, is the deadline for states to decide how they will be complying with the Affordable Care Act.

The Nebraska Department of Insurance has been presenting programs outlining the state's option for complying with the ACA. Nine public input programs have been or will be presented around the state. There was one in Gering on Aug 27; Kearney on Aug 28; and Nebraska City on Aug 30. The rest are scheduled in Lincoln this week and Omaha and South Sioux City on the 10th and 11th.

The main discussions in the informational meetings revolved around how to set up insurance exchanges, the market where individuals and small businesses will buy private insurance coverage when the program begins on Jan 1, 2014. The exchanges will facilitate comparing, selecting and purchasing coverage; certify qualified health plans; determine eligibility for tax credits; facilitate enrollment and provide consumer support.

Nebraska has three options: 1) to operate its own exchange; 2) let the federal government run the exchange; or 3) set up a state/federal partnership.

Have you ever been assigned to oversee a project that you thought was a bad idea? It's really hard to focus on getting the task done without getting mired down in negativity. That is the position the Governor is currently in.

But according to Martin Swanson, assistant project organizer for health insurance in Nebraska and one of the moderators at the meetings, "This is the law of the land. The federal government will form exchanges in states that don't form their own."

What's harder than implementing a project you don't believe in is implementing a project that you don't believe in and has not been well-defined.

Strike three is the fact that it will be terribly expensive to implement -- computer technology alone for the exchanges are estimated at $90 million in Nebraska. Maintenance and staffing are estimated at $20 million a year. Federal grants will help states with implementation and establishment; but the exchanges must be financially self-sustaining in one year, by Jan 1, 2015 - either through user fees or taxes.

Not only will there be challenges for financial resources, just getting enough insurance providers to play in the game will be a challenge in Nebraska. Swanson said Nebraska needs seven insurance companies "and four smaller players" to make the system work.

If that isn't enough, Nebraska questions whether or not they will have enough people and small businesses participating in the health exchange to make an independent exchange self-sustaining. Current estimates are that about 100,000 Nebraska residents and 20,000 small businesses would use the exchange.

The governor has said that voters will send a strong signal about how they wish to proceed in the Presidential and Congressional elections on Nov. 6. If President Obama wins re-election, the healthcare law will move forward. If Republicans take control, they have vowed to repeal it.

It would be unwise for Nebraska to wait until Nov. 6 to finalize its ACA plans.