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OUR OPINION: North Dakota should accept feds' insurance offer

North Dakota's insurance commissioner is undoubtedly right to suggest that the federal government take the lead in establishing the bureaucracy that will support federal health care reform.

N.D. Insurance Commissioner Adam Hamm
North Dakota Insurance Commissioner Adam Hamm listens to healthcare agencies and providers in Bismarck at a Nov. 10, 2010, stakeholders meeting. (AP File Photo/The Bismarck Tribune, Mike McCleary)

North Dakota's insurance commissioner is undoubtedly right to suggest that the federal government take the lead in establishing the bureaucracy that will support federal health care reform.

The key issue is a new health care exchange that the federal legislation requires.

Adam Hamm told legislators last week that he had concluded it would be better to let the federal government establish the exchanges. To get the job done at the state level would be daunting, he said.

The deadlines are simply too tight. Certification is required by the beginning of 2013, and the exchanges must be operational by 2014, when most of the provisions of the health care bill become law.

Writing the rules initially seemed attractive to states, including North Dakota. Regulators and legislators saw this as a way to lessen the impact of the pending legislation.

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Sober reflection suggested a different outcome.

State exchanges could be subject to endless objections from federal regulators. Federal regulators, however, would have to satisfy themselves if they established the exchanges.

In other words, if the feds establish the exchanges, they'll assume the risks. The exchanges will be ordered according to their rules.

The states, including North Dakota, would assume operational responsibility for the exchanges after they'd been established.

That's why George Keiser's objection to Hamm's plan rings hollow. Keiser, a Republican like Hamm, is chairman of the legislative committee reviewing North Dakota's response to the health care legislation. He demanded that Hamm name a single program that the feds run more efficiently than state governments.

This is an appealing argument to conservatives opposed to health care reform, but it overlooks the obvious. Health care reform legislation is the law of the land.

The exchanges do present a Hobson's choice. Not establishing an exchange is not an option under current legislation, which is in effect until it is overturned.

That's an option that both Keiser and Hamm might endorse, but it doesn't seem likely given the political realities in Washington.

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Even if the 2012 elections were to bring Republicans to the White House and majorities in both houses of Congress, the legislation couldn't be repealed in time. States need to be working now to establish the exchanges that are required.

The possibility that the federal government would establish the exchanges and later turn them over to states represents a significant compromise.

North Dakota ought to seize it.

That's the way to capture the benefits of the new health care law while at the same time seeking to improve it.

Mike Jacobs for the Herald

Related Topics: MIKE JACOBS
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