PART TWO The Senate bill lays the responsibility for paying for the exchanges on the backs of the states. Even though for the first few years, until Jan. 1, 2015, the bill provides for financial grants to be given to individual states for this purpose it is doubtful these monies will fully cover each states costs for their exchange. Moreover, the bills plan for each state to fund its exchange which is that it gives each state the authority to charge a fee to the insurance companies that offer health insurance through the exchange is inadequate. States have to be mindful that any fee charged to these insurance companies will be passed on to consumers so the fee will have to be modest which means from a practical standpoint that the money each state gets from this fee and the other general revenue raising power given to the states by the Senate bill will not be sufficient to cover the cost of operating the exchange so states will be saddled with another unfunded federal mandate that they have to pay for out of their general revenue fund. These cost considerations make this individual state exchange idea a disastrous, extremely dumb idea. States cant afford this exchange mandate, many states arent even fulfilling their Federal Medicaid mandate because they cant afford it. Is the Senate oblivious to what is currently going on in the states? Many states are cutting staff and raising taxes, they are fighting to avoid or are in a financial crisis! The Senate should amend this bill and scrap the individual state exchange idea and adopt a one exchange idea run by the Federal government like what is in the House bill. The House bill on this topic is pretty good except for the Houses idea to actually have the exchange register Americans in individual private insurance plans which is foolish because it is an unnecessary expense, leave that task to private insurance companies. If the Senate adopts a one federal government exchange idea, it is more efficient and thus cost effective than a fifty or individual state idea. In the fifty state idea, collectively the states will have an enormous amount of duplicative staff such as insurance experts, lawyers, IT professionals and management, etc.; eliminating duplicative staff in the one exchange idea will save an enormous amount of money. Plus, in the individual state idea what the country will have is state employees enforcing federal government laws and regulations promulgated by the U.S. Secretary of H.H.S.. It seems pretty nonsensical to expect state employees to enforce well federal laws and regulations especially when one considers that to a large degree it will be in individual states interests to make available low cost health insurance to their citizens which the Federal governments regulations will often work against. Even disregarding the state enforcing federal regulation issue to operate an insurance exchange well, that is, insuring good plans are offered on the exchange, monitoring these plans and performing all the exchange customer service functions well, etc. will be an enormous challenge - America will be fortunate if it can get one exchange to run well let alone fifty. In addition, it will be easier and less costly for insurance companies to deal with one exchange compared to numerous exchanges because remember some insurance companies sell health insurance in multiple states and also human nature being what it is exchange staff in different states will likely in some cases interpret regulations differently thus requiring private insurance companies to in effect jump through different hoops to get their plan placed on different states exchanges. Lastly, having a fifty state exchange system will design vulnerabilities for corruption into the health insurance system across the nation. Remember, exchanges will have discretion on what insurance plans they offer on their exchange; instead of having one management staff that needs to be ethical which the one exchange idea would require, the nation will need fifty management staffs to be ethical in the individual exchange idea the Senate is living in a fantasy world if they think the latter scenario will occur! III) The Senate Democrat leadership is really behaving in an egregiously underhanded manner with the public option provisions in the Senate bill. The majority of Americans dont want a government run single payer health care system, they recognize that it will lead to health care rationing and hold back advancement and excellence in health care for patients. Wise Americans recognize that the public option is absolutely a bad idea because it will put the nation on a course for a single payer system because the federal government will not be able to resist the temptation to mandate Medicare like health care provider prices for the public option and once this happens the public option will have a cost advantage and will be able to undercut private insurance companies on premium prices which will eventually drive the private insurance companies out of the health insurance business. So to address this huge concern amongst Americans our esteemed Democrat Senate Leaders publicly proclaim we got the message loud and clear and what we will do is we will write into the bill that the public option has to negotiate prices with health care providers just like private insurance companies. So our esteemed Democrat Senate Leaders have preserved fair competition in the health insurance industry, right? Wrong, immediately following the provision in the bill requiring the public option to negotiate prices is a provision mandating that the public option insurer is not to be charged higher than the average price charged considering the prices charged to all the insurance issuers listed on the exchange (Sec.1323(b)(6)(B)). This means that the public option issuer has a built in by law competitive advantage over at least some of the private insurers. Congressional leadership is beginning, that is from day one, this public option initiative with this competitive advantage for the public option issuer and they expect proponents of a strong private health insurance industry to trust them that they will maintain a level playing field for private insurance companies to compete. This leadership is out of its cotton-pickin mind, the American people shouldnt trust Washington one iota on this issue, the American peoples position on this issue for Congress should be Congress dont even open up the door for the public-option, dont even include it in the reform bill to any degree because we the American people dont trust Washington on this issue! The other thing about the Senate bill that is not widely known amongst the American people and should make Americans unsettled about the public option involves the way the bill implements the public option. The way the Senate bill implements the public option is that the bill instructs that the Secretary of H.H.S. is to hire a vendor to be a contract administrator for the public option insurance issuer for each and every state, the contracts are to run five to ten years and this vendor scheme appears from the bill to go on in perpetuity (Sec. 1323(e)). One of the extremely important concerns amongst the American people with this reform bill is that the Federal Government is not with this public option initiative creating another entitlement program which puts the American taxpayer on the hook to pay for it because the American people cant afford it! To ordinary Americans this public option as the saying goes looks, smells and tastes like an entitlement program! Democrat Senate leaders like to often sound off that they are doing what the American people want, Let this leadership do a poll amongst the American people on this contract administrator initiative for the public option and see how many Americans think this is a good idea!