Fifty, Nifty United States in Charge
Many opponents said that the passed health reform legislation amounted to a "federal government takeover" of health care. That, like many of the myths we've heard for the past year, is false.
Most of the implementation work is now up to the states. According to Cindy Mann of the Center for Medicaid and State Operations, "We're very clear we have to pass the baton to states."
According to the Washington Post, states have considerable control over how they operate their own exchanges:
States are free to decide how many exchanges they operate, whether they create exchanges on their own or in concert with others, and how they administer those exchanges.
Even though states have deadlines to hit, some are taking the lead and implementing changes immediately. According to the Post:
Many states are steaming toward the deadlines. Connecticut said last week it asked the U.S. government to put 45,000 people on Medicaid using the new criteria. It currently covers those citizens with a state assistance program and expects to save at least $53 million over the next 15 months.
It is clear that the bulk of the work will be done in the state level, not in Washington, D.C. The governor of the state of Washington, Christine Gregoire, said it best:
Washington [state] is going to lead the nation in implementing health care reform, we're going to help more people get coverage, make sure our health care industry is ready, and save taxpayer dollars.
It's now up to the state governments to design exchanges and markets that work best for their citizens. The health reform bill laid the foundation, and now states will have a heavy hand in making sure that everyone has access to quality, affordable health care.