EXCUSE: We have to do it now so the Fed. Govt. won't control it. If we don’t write it, the Federal Government will and we will have lost any control over what is in it.
(a) The Exchange is not even required until January 2014, so there is no rush.
(b) Once a state takes any funding for the PPACA the federal government will be able to control anything the states does within the PPACA.
(c) It will not matter if the state develops the exchange itself because Health and Human Services has been given very liberal powers to do almost anything they please under this bill. Therefore even if the state creates the exchange, the federal government will change it to suit them. However, if the state does not develop it, there is little chance that the fed. govt. will write it for that state, and it would likely fall apart.
(d) By not creating an exchange, PPACA may be killed, since the federal government did not provide funding for their creation of exchanges (even though the fed mandated that they would create them if the states did not).
(e) If the state doesn't create the exchange, then along with other states, it forces the bill to be reopened, and the US House would most certainly kill the bill.
(f) The Government determines "Qualified Plans".
(g) The Act prescribes the minimum essential benefits that must be included in a plan and gives authority to the HHS Secretary to prescribe more. HHS is also required to establish the criteria for the certification of health plans as “qualified.” As a result, only HHS-approved plans may be sold in the exchange.
(h) “An Exchange may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary .” Further, the Secretary and the General Accounting Office will have continuing oversight over exchanges.
(g) The federal government controls who can practice medicine.
(h) The federal government controls the doctors and other providers that are allowed to participate in an exchange-offered plan. The Act mandates that only providers who “implement such mechanisms to improve health care quality as the Secretary may by regulation require” may participate in a “qualified plan” offered on the exchange.
(j) The Act prescribes the minimum essential benefits that must be included in a plan and gives authority to the HHS Secretary to prescribe more. HHS is also required to establish the criteria for the certification of health plans as “qualified.” As a result, only HHS-approved plans may be sold in the exchange.