Jay Himmelstein, MD, MPH: Health Care Exchanges

health research exchanges are essential
part of obama care of health reform this year uh… and there’ve been a group of states
massachusetts among them that were part of the early innovator
group that were out beachfront got funding initially uh… very early on to
build both the technology and the policy infrastructure testing the properties
exchanges exchanges will be the central role of
expanding coverage through increasing the medicaid a program expanding
medicaid program and offering advance will tax credits uh… two
people below for tips on poverty these ten or twelve states have moved
ahead in and have have already registered to become state based
exchanges uh… and twenty fourteen the challenge now that it’s the bomb has
been re-elected uh… is how can we bring these other thirty to forty states up to speed quick
enough so they can be ready to put into law when twenty fourteen that what’s happened is the fed’s have
created a lot some flexibility that wasn’t this in a row initial law really did not plan for so many states to be uh… refusing to implement the law
locked reluctant to meet with mark and i think so they’ve created three options four
states uh… you can go ahead in the state
basics chains like massachusetts and and ten other children do uh… you can uh… default uh… is in the system happening to me
and states uh… that uh… that uh… to the federal change uh… or now you can get the in what
work with the corn partnership exchange with the fed’s takeover initially some of the functions and really work very close to the states
to get them prepared eventually being acid-base exchange one of the ocean
possibilities that might happen now that obama’s been reelected is that a lot of the states that were reluctant
to get involved health reform they had the uncertainty related to on the
supreme court decision had been certain that the election now that’s clears the
law the land it’s like a sweet increasing pressure
for many of those states many which are led by republican governors uh… to relook at that obama care uh… and look at it in terms of the
interests of the state’s those states you know that the hospitals in the
states insurance companies in the states and of course the consumers in the
states have a lot of interest in seeing obama came forward is their way that those states who have
been lucky can be brought on more quickly and one of the most inching
aspects of this is that uh… the federal change which was
really originally thought of as a threat lookit here together offer your you know uh… offer your own state this exchange
where you’re going to have the state’s common among your insurance systems i
think that’s going to come back and i think a lot of states and much more
interested in leveraging the resources of states like massachusetts another
early innovators to see if they can use those resources and partner with other
states rather than being subjected to the federal uh… government deciding who’s gonna be
a little for the medicaid program and how their insurance markets a

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