HELENA — The federal government is giving states like Montana another chance to run at least parts of the insurance exchanges that are part of the federal health care law.
Montana Insurance Commissioner Monica Lindeen said developing federal rules opens the way for more state involvement in the health insurance exchanges, even in places like Montana where the legislature rejected an option to have the state run the exchanges with federal grants.
Republicans in the Montana Legislature, working to undermine the federal law generally reviled by conservatives, shot down any attempt to let Lindeen's office run the insurance exchanges. Lindeen and others argued unsuccessfully that it makes more sense for Montana to run it than the federal government.
Only about a dozen states fully embraced the idea of taking federal money to set up their own state-run insurance exchange, the U.S. Department of Health and Human Services has said.
The exchange, a key part of President Barack Obama's health care overhaul, is designed to help uninsured people buy coverage from a choice of plans, often with federal tax credits. The agency earlier this week announced the framework for new rules intended to give states more options to help design and run parts of the exchanges without state legislative approval, Lindeen said.
Lindeen said options include having states handle consumer advocacy work, such as fielding calls from consumers with money from federal grants. Lindeen argues Montanans should help decide how their exchange works.
"Most Montanans would agree that they would rather deal with the state consumer insurance office to deal with consumer issues," Lindeen said.
Under the health care law, the federal government will impose its version of the exchange on states that don't set up their own.
In Montana, some Republican legislators have suggested that some among their ranks could be convinced to eventually change their mind about the exchange in order to avoid a federally mandated version.
But many in the GOP remain steadfast that it is a bad idea. They argue the state should not be complicit in implementation of the health care law surrounded by uncertainty.
Republican State Sen. Jason Priest of Red Lodge, active in the Legislature opposing state implementation of the federal law, said Lindeen's office should not use its authority to help with the federal exchanges.
"I think it is absolutely irresponsible to go against the will of the people who have opposed this law. But we can't stop her," Priest said. "I think it is absolutely irresponsible to burden Montanans with implementation of Obamacare."
Lindeen said she will be meeting with stakeholders, such as medical providers and patient advocates, in the coming weeks to discuss ways the state could be involved.
After that, Lindeen said she will make a decision on the exchanges. The Democrat remains confident that Montanans would rather deal with the state on the exchanges rather than the federal government, making it worthwhile to explore the issue despite the controversial nature of the federal health care law.
"I think there is a significant value in having the state have control, at least in portions of this," Lindeen said. "Obviously if I was completely concerned about the politics of this issue I would be backing off. But I am not concerned about the politics. I am worried about doing what is right for Montana."