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Obamacare: It's a different law in red states

Republican lawmakers have engaged in 'massive resistance' to the Affordable Care Act.

By Money Staff Oct 11, 2013 12:04PM

This post comes from Jen Wieczner at partner site MarketWatch.


MarketWatch on MSN MoneyIt seems unthinkable that any group would decline $833,000 in federal funding. Yet Cardon Outreach, a Woodlands, Texas-based organization, did just that -- returning its chunk of $67 million the federal government set aside to guide uninsured Americans through getting coverage under the Affordable Care Act.


Insurance Money © Comstock Images, JupiterimagesThey refused the cash after Republican congressional representatives and the Oklahoma insurance commissioner put a gag on what these "navigators" could discuss with consumers during enrollment. Cardon’s lawyer Chuck Kable worried that their ability to help would be so limited, navigators might actually discourage frustrated consumers from enrolling at all.


"Are you providing a disservice to the individual by taking them halfway and then saying, 'Sorry, I can't go any further?'" he said


The ongoing political hostility to Obamacare -- most recently taking the form of the government shutdown -- is having the greatest impact on consumers living in states where elected officials are opposed to the law.  Twenty-seven states -- many of them led by Republicans -- refused to set up their own health exchanges entirely, leaving them to the federal government to take care of.


But some states have taken their protests a step further and launched legislative battles and lawsuits. Oklahoma, for instance, is currently suing the federal government, claiming that awarding premium subsidies is unconstitutional in states with federally run exchanges (if it's successful, the suit would effectively prevent an exchange from operating there at all, experts say).


"The federal exchanges are really swimming upstream in these states," says Timothy Jost, a law professor at Washington and Lee University who is studying health exchanges.


Henry Aaron, a renowned health care economist and senior fellow at think tank the Brooking Institute, compares the red state movement against Obamacare to the 1950s policy of "massive resistance," the name given to efforts by some politicians in the South to prevent black children from attending school with white students after the Supreme Court's landmark desegregation ruling. Indeed, a September survey by the nonpartisan Pew Research Center found that 23 percent of adults want elected officials to try to make it fail.


"The idea that you have a duly passed law, confirmed by the courts, that is affecting tens of millions of people, and you have state officials doing everything in their power to block the enforcement of the law of the land," says Aaron, "is in the same corner of the box, so to speak, as a massive resistance."


Congressional budget bills to defund and delay Obamacare are perhaps the most high-profile acts of defiance yet -- aside from the 41 times House Republicans have voted to repeal the law -- but states have also rebelled at the local level.


South Carolina proposed to refund residents who pay a penalty for not having insurance next year, effectively canceling out the law's coverage requirement. Florida banned navigators from county health departments, "keeping that piece of health reform away from the population that’s going to need help," says Bill Melville, market analyst for Decision Resources Group, a health care data firm.


In Georgia, the insurance commissioner publicly declared himself an Obamacare "obstructionist," while Missouri prohibited state agencies from promoting the law, and created licensing hurdles for navigators that other states have copied. "Missouri emerged as a sort of anti-pioneer," says Melville, who published a report card grading each state’s exchange -- flunking Missouri and assigning D grades to South Carolina, Florida and Georgia. (Alabama, New Hampshire, North Carolina and Oklahoma also received Ds, for placing similar restrictions on navigators as well as for lacking insurer competition.)

The real losers in this fight may be the consumers who actually want health insurance in those states. They may have to pay higher prices for coverage, which some critics have blamed on lawmakers’ relinquishing control of the marketplace. And if constituents approach their state representatives with questions about the law, some Republican congressional representatives decline to answer.


"We direct all questions about the program to," says Tennessee Rep. Diane Black’s press secretary, Tom Flanagin. "We have serious privacy concerns about the exchanges, and concerns about the program in general." (Tennessee got a C on Melville’s report card, earning points for relatively low insurance rates in spite of state officials' objection to the exchanges.)


Indeed, much of the obstructionist regulation has focused on blocking assistance for consumers -- either literally banning navigators from certain locations, as in Florida; creating other barriers, such requiring navigators to pay fees or obtain surety bonds; threatening to penalize navigators who go beyond their job capacity; or requiring the navigators to undergo additional tests and training.


To be sure, Georgia’s requirements that navigators take a state course on top of federal training and pass a state licensing exam "are intended to protect the consumers in Georgia from fraud, not restrict them from obtaining coverage," says Glenn Allen, a spokesperson for the Georgia Department of Insurance. But several days after the exchanges opened, Georgia had only nine licensed in the entire state. "People are going to need help, and the assisters and navigators are important—and without them, it’s going to be a rougher road," Aaron says.


Still, in some parts of anti-Obamacare territory, health insurance officials and most navigators are pressing on. In Florida, the U.S. Department of Health and Human Services is "doubling down" to "provide Floridians with the information and assistance the state is committed to denying them," enlisting mayors, local pharmacists and religious leaders to educate people about the ACA despite the "shameful attempt by the state to block the law," says HHS spokesperson Joanne Peters.

And at Oklahoma’s Little Dixie Community Action Agency, the task is "black and white," says Chad Austin, who is coordinating the navigator program. The recipient of a $580,733 navigator grant, the agency is based in a rural area where "there’s a very good likelihood that some people don't even know that the Affordable Care Act exists," Austin says. "There’s a lot of political controversy over it right now, but that's what makes my job even more clear."


Austin says he plans to adhere to Oklahoma's navigator limits by supervising and checking in with his staff, and handing people a list of brokers’ phone numbers when they ask questions navigators aren’t allowed to answer. "I don’t want my family or my friends or my community members to not have health insurance and have to pay a fee because they didn’t know they were supposed to get it."


More from MarketWatch:





Oct 11, 2013 1:34PM
Americans should take responsibility for their own health and wealth and get the politicians out of our lives.
Oct 11, 2013 1:27PM

Mr. Obama said “You did not build that, the government built that”. What he does not understand is that the government is here to serve the common U.S. citizen not the other way around. It is funny illegal’s can get in the national mall during a government shut but the veterans cannot get into an open air memorial. To make this country great again we need to respect each other’s ideas and lower taxes. I don’t always agree with the republicans, but they seem to be going in the right direction instead of the left wing nuts that want to take every penny I work for, so the welfare check can keep flowing to the illegal’s.

Oct 11, 2013 1:03PM
I don't want Obamacare for my choice of health insurance.  I don't want the government in charge of my health and well being.  Who is going to stand up for me?
Oct 11, 2013 1:03PM
Well Henry Aaron there is one big difference. In the 1950's the president didn't exempt some schools and allow them to keep those black kids from going to school. Obama has picked and chosen favorites to exempt from his law and it is set up so the politicians don't participate either.... There is the difference.......... "There's Your Sign"
Oct 11, 2013 1:34PM
Obamacare is different all right!  It was shoved  down our collective throats and it is a disaster.
Oct 11, 2013 1:34PM

My grandfather built this country and fought in WW2. I have tremendous respect for that man, but I have very little respect for the flower children who took America for granted and sold us out. I am all for the shutdown if it make the U.S. live within its means. Sometimes thing’s have to get worse before they get better.

Oct 11, 2013 1:38PM
Obamacare is just another Socialist program. It was supposed to cost around 60 million to set up. It cost almost 700 million to set up. Medicaid has ballooned up in cost. Which has stopped funding increases for education. Now it takes more money for middle class to receive a higher education. Welfare costs have greatly increased because of these Socialist programs. Now we are going to have more welfare. Why work if you can receive everything free.
Oct 11, 2013 1:47PM
Let's see...27 of 50 states are against Obamacare. Maybe someone in Washington needs to listen to the people of this country. Obamacare is a train wreck. The fed can't even manage delivery of the mail.
Oct 11, 2013 2:03PM

It is a funny thing when a man can be elected to the presidency of the United States of America not for his ability to lead nor his ability to unite but for his promises of free stuff and ability to polarize people against one another not only on race but also class. I would take no pride being given a job to do when a common comment made is he was the lesser of 2 evils. This was an ill thought out piece of feel good legislation that a democratically controlled government shoved on us which they still don't know what's in it after 5 years. Heck the supreme court had to change it to a tax for them just to make it legal. TERM LIMITS FOR ALL NO MORE CARREEER POLITICIANS OR JUDGES PERIOD.     

Oct 11, 2013 1:43PM
Obama care will never be affordable unless they do away with those insanely high deductibles. Who cares if your premiums are $93 a month when your deductible is $5,000! What this means is that even though you pay your premiums every month you have to spend and additional $5,000 out of pocket before your insurance will pay for anyting. There is nothing affordable about that, especially if you have kids because your deductible can be as high as $15,000 for a family of 4.
Oct 11, 2013 1:25PM
Good for them.  Nice to see real Americans standing up to the foreign terrorists in Government.
Oct 11, 2013 1:31PM
We have to buy auto insurance no problem.  Why can't we buy health insurance the same way?  We already have medicare for the ones that can't afford it.   And why attached stuff onto the law that has nothing to do with insurance?

Oct 11, 2013 1:45PM
What bothers me is using tax codes to be the enforcer to buy insurance. I think this is just a way the government is using to know where everyone is at all times and to increase the method of tracking each and everyone of us and how much income we have. Now tracking the income is one thing for making sure people pay their taxes but this seems to go beyond the normal method of a tax system. I believe the authors of the ACA/Obamacare knew this and being lawyers for the most part understood what was in it from the start. They also know and probably took advantage of the fact that the highlights they presented didn't truly represent the full disclosure of the final product. With this method they pushed for passage by saying, "You must pass this to see what is fully in it", but as lawyers they know that as with any contract once you sign the contract you are legally bound to it. They obviously took advantage of everyone knowing full well the contract would stand as written because as everyone knows, signing a contract without knowing what is in it is no excuse for trying to void it. If this is the way government is working now then we really need to get people in office that can put the politicians and the political processes back to where they are serving the country and not the government, the political parties, and the politicians.
Oct 11, 2013 1:51PM
Good! It's unconstitutional to force the population to buy a product. We should be standing against this to the point that we're linked arm in arm to show that we don't want this.
Oct 11, 2013 1:44PM
Is this from a journalist or from a White House propagandist?
I guess if you want to hear unbiased information MSN isn't the place.

Even if you are "for" this, can you believe a news agency can give such a slanted story?
Oct 11, 2013 1:37PM

The lazy, arrogant, corrupt imbecile Obama and his socialist henchmen will not win this.   Only the extreme risks, and people who will want massive amounts of healthcare will sign up.   Their will be few idiots that sign up to PAY for these people. 


Do yourself a favor.  If you sign up, make SURE you use far more in services than you pay in premiums, otherwise DON'T sign up.   Otherwise all you are doing is paying for someone else.


Fight this every step of the way.   More importantly, until this is repealed DO NOT VOTE for any DemocRAT on the ballot in any election.   These people are your enemies if you WORK for a living...  Treat them like a Jew would a Nazi...

Oct 11, 2013 1:51PM

Y'know, the Jim Crow laws themselves were "duly passed by legislatures (state not federal, but still) and upheld by the Supreme Court (Plessy v. Ferguson)", is that really the standard we want to use for whether a law should be challenged?  Oh no, Obamacare might only be available in some states and not others.  Then we'll see if the states with Obamacare fare better or worse that those without (my money's on the latter).  Gosh, then a bright spotlight might be shown on the failure, instead of the misery being spread around to all 300 million Americans.  Can't let that happen.


Here's a tip, if you want Obamacare, move to a state that's embracing it.  Let me know how that works out for you.

Oct 11, 2013 2:23PM
Overall, it's a great idea.  Get as many people as possible addicted to government assistance and you lock up their votes forever.  How hard is it not see what this scum bag is doing?
Oct 11, 2013 2:10PM
Gee, is it possible that maybe ObamaCare isn't such a good thing as got rammed down our throats?  Why else would there be so much resistance to it?  Fact is,  Obama DON'T Care.
Oct 11, 2013 2:07PM
MSN, why do you put a picture of the State flag of Texas on the main page, There is not one mention of Texas anywhere in the article. Do you use our flag to defame our state just to get readers?
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