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DES MOINES, Iowa – Gov. Terry Branstad notified federal officials Friday that Iowa policymakers intend to create a state-based health insurance exchange under the Patient Protection and Affordable Care Act but need many questions answered before they will be in a position to proceed.
To that end, Branstad sent a letter to Kathleen Sebelius, head of the U.S. Department of Health & Human Services, detailing 50 questions he wants answered to make an informed decision and criticizing the "intrusive" federal mandate.
"I cannot provide you with a set of timelines or complete details about the exchange until our state receives clear, binding rules from your department," Branstad said in his letter.
"Forcing an exchange decision on states based on an arbitrary timetable, would be like forcing a consumer to buy a car without knowing the vehicle's price tag or fuel economy," he added. "If forced to make a decision with incomplete information, then I have no choice but to default on some level to a federal exchange. That is not my preferred path forward."
The federal legislation allows states to implement their own exchanges, enter into a partnership with the federal government or allow federal officials to spell out operations of an exchange for them.
Under the health care exchange, individuals and small businesses would use the new framework to shop for health insurance among competing private plans and receive subsidies. The law – intended to make health coverage available to most of the uninsured – calls for legislation to be enacted before Jan. 1 or the government will step in to establish a federally operated exchange.
Branstad spokesman Tim Albrecht said the governor's letter was intended to abide by an "arbitrary" notification deadline that was set for Friday but pushed back to Dec. 14 "because the federal government does not have the answers or capability to administer the Obamacare program."
"This deadline was not pushed back to give the governors more time, rather it was a lifeline to help save themselves," Albrecht noted.
However, Sen. Jack Hatch, D-Des Moines, the lead person on health-care issues for Democrats who hold a majority in the Iowa Senate, called on Branstad to "stop playing partisan political games" and start helping improve the health care of Iowans.
"While 17 other states are making health insurance better and easier to purchase, Iowa's governor is complaining about 'process' rather than catching up," Hatch said in a statement. "Iowans of both parties simply want Gov. Branstad to work with the Obama administration to make buying private insurance easier and to help uninsured Iowans."
The Senate Democrat said federal officials agreed to a request from GOP governors for additional time to determine how best to go forward in establishing their health-insurance exchanges and he hoped Sebelius' overture will convince Branstad "to stop complaining and start working on solutions" with federal officials, state lawmakers and Iowa health care providers and consumers.
In his letter to Sebelius, Branstad said his top priorities as governor are to protect the health, safety and welfare of Iowans, promote Iowa's fiscal well-being and ensure the state remains a leader in job creation and income growth.
"I continue to have concerns that an intrusive federal exchange would raise costs on individuals and businesses, making it harder for them to create jobs and raise family incomes in Iowa," he wrote. "In fact, I have even greater concern that the health benefit exchanges proposed in the Patient Protection and Affordable Care Act (PPACA) do nothing to address the quality of care or make our population healthier."
Branstad said he has pledged to work in a bipartisan fashion with Iowa legislative leaders and federal officials to create an exchange but the path to consensus rests with HHS leadership in Washington.
"Our intention is not to default to a federal exchange," Branstad said in his letter, "but the road blocks and impediments in front of us may leave us no choice."
Sebelius, as a former governor of Kansas, is familiar with the challenges state face in "trying to navigate the murky waters of implementing a federal mandate without clear guidance," Branstad added. He said Iowa officials have met all of the deadlines for health benefit exchanges, are updating vital systems and technology within the state, have met with critical stakeholders for input on exchanges, and have a solid framework for how an exchange could operate in Iowa.
"However, we continue to struggle with too many unanswered questions on topics critically important to the final development of an exchange that meets the needs of Iowans, including the cost of building and operating an exchange," Branstad added.