Behind the Scenes, Plans for Insurance Exchange

Gov. Rick Perry has made no secret of his disdain for federal health reform or for one of its key tenets, a Travelocity-like state insurance marketplace in which consumers could choose from public and private health plans.

The threat of Mr. Perry’s veto pen evenderailed legislation by one of his fellow Republican “anti-Obamacare” colleagues, who fears that if state lawmakers do not implement a health insurance exchange of their own, the federal government will do it for them — in his view, an even worse fate.

But among Mr. Perry’s gubernatorial peers, his stance on the health insurance exchange appears to be losing popularity: Politico reported last week that the Republican governors Haley Barbour of Mississippi, Mitch Daniels of Indiana andScott Walker of Wisconsin are taking steps to comply with that piece of the law — even as they continue to oppose the federal health care program over all.

Meanwhile, despite Mr. Perry’s stated opposition to a federally-mandated health insurance exchange and the state’s participation in lawsuits aimed at overturning federal health reform, officials at the Texas Department of Insurance acknowledge that since last fall, with the help of a $1 million grant from the United States Department of Health and Human Services, they have been working quietly to plan for a health insurance exchange.

“We’ve been going full speed ahead on implementation, doing the due diligence so that we can be on time with what the law says,” said John Greeley, a spokesman for the agency.

Lucy Nashed, a spokeswoman for Mr. Perry, said the governor is aware of the grant, which she said is exploratory and does not require Texas to set up an exchange. While Mr. Perry prefers local solutions to Texas’ health care problems, Ms. Nashed said the governor remains hopeful the courts will overturn the federal health law. “The governor’s firm belief that Texans should be in charge of our health care programs is unchanged,” she said.

If the courts uphold the health reform plan, states have until 2014 to implement an insurance exchange before the federal government steps in. State Representative John M. Zerwas, Republican of Simonton, who filed the Texas health exchange bill that failed in the session that just ended, said that if the federal government threatened to install a one-size-fits-all program in Texas, “we could, in fact, pull something off in really short order.”

Still, he said, given the antipathy between some Texas officials and the Obama administration, he worries about delays in setting up an exchange.

“I would have some concerns that they would say, ‘You all didn’t bother to make significant efforts with the lead time you had,’ ” Dr. Zerwas said. “I wouldn’t put it past them not to certify what we came up with in a last-minute effort.”

In the end, it may not be so last-minute. The state’s insurance department is using the $1 million federal grant to hire a consultant to consider options for both a state-run and a federally run health insurance exchange.

Mr. Greeley said department officials had initially believed a change in state law would be required to establish a health insurance exchange. Now, he said, “the indication we’re getting is this could happen without it.”

Insurance groups, however, question whether state agencies can do anything constructive without full support from state leadership. Jared Wolfe, executive director of the Texas Association of Health Plans, said Texas’ insurance market is too complex for a blanket federal exchange. “We knew anything related to federal reform was going to be controversial,” he said, “but we’d much prefer to see the state run it.”

eramshaw@texastribune.org