I have always wondered why have separate state and federal exchanges. They all have to follow the federal rules. Why spend all the extra money on a separate exchange?
This explains it. You had to set up the state exchange to get the tax benefits.
yes the obama gang tried to get cute and force Republican states to implement exchanges by limiting subsidies to state exchanges only.
when those states mostly said no, the obama gang then built a federal exchange and tried to skate by a landmine they put in their own legisation.
i believe in some parts of the US this is describled as “being bit by your own dog”
as a canadian, looking at what works and what doesn’t in both the USA, canada, and uk, my suggestion is to take people with expensive pre-existing conditions and put them on medicare and charge them a % of income as a premium, they are not insurable and trying to force coverage is distorting the whole system; let private charities fund low income people who can’t afford coverage and don’t qualify for medicaid; for the rest, get the gov’t out of it and let the private market reduce costs !
Also, they needed the states to enforce the individual mandate, employer penalties, & changes to health care plans... It was unconstitutional w/o forcing the states to run state exchanges. Forbes, has a really good article: