Obama reportedly supportive of House bid to include national exchanges in health bill

The Wall Street Journal: "The White House wants to include a national health-insurance exchange in the health bill, which would give House Democrats one of their top remaining demands, according to an official involved in the discussions." The real issue is "who would run the new insurance exchanges." The House-passed health bill "calls for the federal government to run a single, national exchange, while the Senate's version would let states run their own exchanges." Proponents of the state-based approach suggest that they would offer a more flexible regulation while those supporting a federal program say the state exchanges might be be too small to function well and or be too costly. In addition, the White House "is working to increase the amount of the proposed subsidies that would help offset the cost of buying insurance for lower earners," the Journal reports. The White House is working to get subsidy levels closer to the more generous House levels. Leaders in the House are urging the White House "to support repealing a decades-old federal antitrust exemption for the insurance industry that is part of its bill but isn't in the Senate's version" (Adamy and Meckler, 11/13).

The Washington Times: "Democrats on Capitol Hill are divided over whether health insurance would be sold at the state or national level under their health care reform legislation, one of a series of differences between House and Senate plans that need to be ironed out before it can pass."

"House Democrats said Tuesday that they plan to fight for the national plan. … But advocates of the state idea say the national plan risks overlooking regional differences in insurance coverage and that states already have insurance commissioners and insurance regulatory infrastructure in place, allowing them to more quickly and efficiently set up an exchange." A state exchange is already in place in Massachusetts, which has its own individual mandate on residents to carry insurance. But in some states, Democrats worry Republican lawmakers would stall creation of state exchanges. "In Texas, Democrats are worried that Republican state leaders won't enact or would stall the implementation of a state exchange. Eleven Democratic lawmakers from the state wrote in a letter to House Speaker Nancy Pelosi and Majority Leader Steny H. Hoyer that the House plan would ensure that uninsured Texans would get coverage more quickly" (Haberkorn, 11/13).

Meanwhile, some liberal groups are urging House lawmakers to make a stand and "to insist on keeping the House bill's stronger consumer protections and its federal exchange network, over the Senate's looser rules" CBS News reports (Condon, 1/12).

BusinessWeek: "Obama also backs a House proposal to repeal the insurance industry's antitrust exemption, said the Democratic aide, who spoke on condition of anonymity. … Among those opposed to a repeal of the exemption is Nebraska Senator Ben Nelson, a Democrat who provided the 60th vote that cleared the way for the Senate's Dec. 24 passage of its health bill. Nelson, a former insurance company executive and state insurance regulator, says a repeal would hurt small insurers" (Rowley, 1/12).