Chapman Rackaway: Governor lost bet on health care law

11/25/2012 12:00 AM

11/23/2012 5:14 PM

If Gov. Sam Brownback were a poker player, his opening bid likely would be all-in on every hand.

The tax changes passed in the past legislative session and sweeping proposed changes to school funding, social services and state retirement accounts show how he rarely takes half-steps.

But sometimes that high opening bid ends up losing big money, and another all-in bet appears to be breaking away from the governor.

Brownback bet on Mitt Romney’s presidential bid and his promise of repealing the Affordable Care Act. Romney lost, and now the state will have to implement some version of the insurance exchange mandated by the 2010 law.

So which strategy would the governor take when it came down to the final hand on Kansas’ role in the new health care environment?

One option is that states can establish their own exchanges. However, Brownback already rejected more than $30 million in federal money to build the technological backbone for the exchange.

Option two is for the state and the federal government to split the responsibilities. While states are on the hook for any money beyond the federal grant to the partnership, the state also gains a significant amount of freedom in the administration of the partnership.

The third option is to fold the whole hand and let the federal government administer the entire program.

Brownback opted for the third strategy.

On the surface, the decision seems odd for a governor who believes that states should serve as innovative laboratories for new public policy. Insurance Commissioner Sandy Praeger thought as much when she expressed shock that the state sent its $31.5 million check back to Washington, D.C., in 2011. Praeger believed that Kansas had the opportunity to set up a groundbreaking system that could serve as a cost-effective model for other states. But the governor decided to passively protest the federal imposition through lack of participation.

The other entity whispering in Brownback’s ear was Americans for Prosperity, his essential ally in the primary that wiped out most of the governor’s in-house opposition. AFP press releases stressed the federal government’s veto power over significant decisions made by the state in such a partnership and the fact that states are required to pay any bills that go beyond the annual federal administration grants. Looking at his hole cards, the governor decided it was best to fold and not play the game at all.

The decision to fold to the federal government is an odd one philosophically, if not economically. Brownback has pointed to the federal government as an example of how public policy is administered poorly, so effectively the governor has just ceded all control over a part of Kansas’ health care to a government level he distrusts greatly.

But just like in poker, money trumps all. At a time when the governor’s stack of chips is dwindling quickly, any chance he has to slough more of his costs on to the federal government probably looks like a relief.

For someone used to betting aggressively, the governor has suddenly turned into a very conservative gambler.

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