Short Takes On News & Events

Bill Frist To GOP Governors: Get Cracking On Exchanges

By Marilyn Werber Serafini

July 18th, 2012, 12:27 PM

A former GOP power player is urging Republicans to rethink their rejection of the health law and to implement state insurance exchanges – and to do it now.

(Photo by Win McNamee/Getty Images)

Bill Frist, a former Republican Senate majority leader and heart transplant surgeon, today argued in a column that state officials should not pass up the opportunity to build the insurance exchanges that are right for them. (Under the law, if a state that doesn’t create its own exchange, the federal government will parachute in to do the job).

“Originally a Republican idea, the state insurance exchanges mandated under the Affordable Care Act (ACA) will offer a menu of private insurance plans to pick and choose from, all with a required set of minimum benefits, to those without employer-sponsored health insurance,” wrote Frist, who is also a member of The Kaiser Family Foundation board. (KHN is an editorially independent project of the foundation.) “These exchanges are expected to bring health insurance to an additional 16 million Americans. Unlike the Medicaid expansion, these Americans will gain private insurance, and can choose the plan that’s right for them.”

Fifteen states have taken the first steps to set up exchanges, basically online insurance marketplaces. The health law has received withering criticism from many Republican governors, and some have refused to establish exchanges.  Some were waiting for a decision on the law from the Supreme Court, and are now moving forward. Still others are holding out hope that Republicans will win big in November and repeal the entire law.

But Frist, who isn’t a fan of the law’s insurance mandate, believes state-based exchanges are a good idea.

“State exchanges are the solution,” he wrote. “They represent the federalist ideal of states as ‘laboratories for democracy.’ We are seeing 50 states each designing a model that is right for them, empowered to take into account their individual cultures, politics, economies, and demographics. While much planning has yet to be done, we are already seeing a huge range in state models. I love the diversity and the innovation.”

7 Responses to “Bill Frist To GOP Governors: Get Cracking On Exchanges”

  1. larry cane says:

    Bill Frist could never be elected to the US Senate as a Republican when you look at today’s far right-wing mainstream. We no longer have a GOP that’s stable. When you look a Senators like McConnell and Kyl and DeMint and Toomey, just to name a few, you see politicians that are intent on maintaining strong ties to the Tea Party. They will never compromise on anything. Even within their own party, compromise is a dirty word. In my opinion, they are truly insane people. Mitt Romney was once a moderate Republican. Today, Romney is not allowed to appeal to moderates. The Tea Party has warned Romney not to stray toward the middle in any way. Romney does not have the freedom to be who he really is, a moderate. When Bill Frist tells GOP governors to get cracking on exchanges, he’s giving them sound advice. However, you can’t expect Tea Party governors to risk moving toward the middle and embracing Obamacare in any way. The Tea Party has them in a box. At least 26 governors are trapped by the Tea Party that elected them. They can’t be independent. They can’t make their own decisions. They are trapped! Just like Grover Norquist has almost 100 percent of GOP members in Congress trapped, the Tea Party has most GOP governors trapped. The Tea Party, just like Grover Norquist, has most GOP politicians in a box and unable to be themselves. In my opinion, Bill Frist is wasting his time!

  2. Larry Glass says:

    The current GOP members are like dogs chasing a car: it’s great sport until you catch one and then have to do something with it. In some strange political universe the GOP wins the House and Senate and Romney beats Obama. Then they will be on point to come up with policies and legislation to address health care cost and delivery issues. Vouchers and interstate insurers won’t bring down health care costs or improve care. The problem is not an insurance problem – it’s a system problem. We need a health care system in the US. We can figure out how to pay for it using best models from other countries and innovative thinking (reward doctors and patients for good outcomes, educate providers and the public to follow evidence based guidelines). Medicare For All is the simplest approach. Sliding premium scale based on income. Doctors are reimbursed for good care. Preventive health and chronic disease management are emphasized. Only a national system can set standards for care. These standards are not different in different states – medicaine is universal. We must stop discussing insurance and start discussing health care as a structured and managed system. An American solution will hybridize private institutions and providers with public facilities, give insurers a role in data collection and analysis, premium collection and even claims adjudication (as with Medicare today) if we still have some fee-for-service vestiges. The Republicans will need to be held to account for success in this area should they gain control and even if they remain in the opposition they should be pressured to provide meaningful and evidence supported proposals for reform. Naysaying never treated any disease.

  3. William Presnell says:

    I agree with the synopsis of Larry Glass completely. The Insurance industry through the power of their lobby and the corruption of House and Senate Members kept the narrative focused on the “Governement is the problem / Privatization of everything is better argument” instead of a rational debate about the healthcare delivery SYSTEM. The only way to address the cost and thereby fix the healthcare portion of the deficit is to get the focus off of where the financing comes from and discuss how the delivery SYSTEM can be improved and made more cost efficient. The free market delivery system is by its very nature inherently less efficient and unnecessarily complicated. Think of the multitude of competitors with different methods of claim processing, different ideas about what care is covered, co-pay amounts etc… etc… It makes for an administrative nightmare for practitioners. Doctors professional corporations need highly trained insurance professionals to navigate through all the complexity, In addition to unnecessary administrative cost the insurance company infrastructure expense and high executive compensation siphon off too much of the money that should go to paying for better health care for all americans. To paraphrase the political paradigm of the Clinton administration “ITS THE HEALTHCARE DELIVERY SYSTEM STUPID.’ Mr Glass is right the discussion should be about more cost effective ways of getting patients the healthcare they need. Somehow the argument got highjacked and the narrative morphed into a divisive battle about whether improving the healthcare system was a socialist assault on capitalism. Once the focus changed all the rhetorical exchange got bizarre and hatefully divisive and all hope for well reasoned debate designed to create the best solution was lost.

  4. larry cane says:

    There’s nothing “well reasoned” about the health care debate in Congress. The only “well reasoned” debate coming from inside the beltway is coming from former members of Congress like Bill Frist that no longer receive massive cash infusions from the special interests groups to say and think like a puppet. Simpson/Bowles (two former members of Congress) is another example of ‘well reasoned” debate. The debate among active members of Congress is driven exclusively by money, plain an simple. It always has been and it always will be thanks to our Supreme Court. The Robert’s Court has spoken, “Money talks and BS walks”. If you are expecting “well reasoned” debate coming from the seventy or so members of John Boehner’s Tea Party caucus, I suggest you not hold your breath.

  5. Mark says:

    You wish the health mandate was in effect now to see who mainstream Ameica would blame for it..

  6. larry cane says:


    What’s an “Ameica”?

  7. larry cane says:

    Is that some sort of new prescription drug, huh?