Perdue's Choice

While some have criticized Governor Bev Perdue’s choice of a state-federal option for the health insurance exchange a closer examination of her choices indicates she chose the best one available to her at the federal deadline.

The Affordable Care Act, as upheld by the U.S. Supreme Court, mandates that every state institute a health insurance exchange, providing three options. Each state can choose to operate its own exchange, can participate in a state-federal shared administration or can choose to let the federal government operate the exchange.

Governor Perdue and North Carolina had little choice. We will have a health insurance exchange come 2014 and there is no question who will pay to administer the exchange. Each state must pay its own costs, whatever type of exchange it chooses. North Carolina did not have the option of a state run health exchange because our legislature did not authorize it. The House passed legislation to do so but the Senate hoped the ACA would be struck down by the courts and didn’t consider the legislation. That option was off the table for Perdue. So the only decision available to Governor Perdue was who was going to run the exchange. Ideally we would want North Carolina people doing so, but since authorizing legislation wasn’t passed in time for September’s deadline there were only two options available to Perdue.

The third option would have turned total control over to the feds, running afoul of those who already think government in Washington has too much control over us. The only reasonable option was to choose a state-federal joint plan. Had she not taken action the control would have been ceded to Washington.

We can hope these options can be reconsidered because there was much left unsaid in the ACA and it would be nice to have more information and another chance to make a decision. But under the circumstances Governor Perdue made the right choice for North Carolina.