What Health Care Federalism Looks Like

Insurers are beginning to grumble about the state-by-state variation in Exchange design as implementation bears down on the industry.  Fierce Health Payer has a quick summary of the griping here.  While I can’t blame them for their frustrations (hey, we have to figure out all 50, too!) I do wonder how they would feel about the alternative: a national exchange whose model may not adequately recognize the dramatic differences in how care is delivered by geography, demography, provider culture, et al.  Just look to the Medicare Advantage program and its challenges thus far in creating a quality rating system that does not properly account for the challenges in caring for a rural population.

Curious to know your thoughts, dear readers, on the virtues of the open vs. closed models….