The states that have refused to set up the 0-care state exchanges must recognize that there will be an insurance coverage vacuum. In 2014, it is likely that employers will massively shed employees from their employer sponsored pans and pay the fine (likely required), or get below 50 employees for medium and small businesses.
In the non 0-care states, non-covered individuals may still be required to pay the tax-fine (TBD) if they don’t get their own high priced insurance in the individual market.
In the meantime, these conservative states need to set up their own real healthcare marketplaces based on real free market principles. In ths vacuum, they need to pass legislation that permits insurance companies to set up plans tailored to the consumer. That includes high deductible plans, limited benefits plans and plans w/o all the coverage mandated by 0-care. Bring in insurance executives and ask them to design free market individual and group plans. Permit insurance companies companies to continue rate risk and deny pre-existing disease coverage for individual plans. Menu pricing should also be required. We also need to rigorously explore the legality of some of the healthcare ministry exemptions.
Of course, we all know that many if these plans will not sufficiently comply with the HHS standards and 0-care. However, patients could still get adequate insurance coverage to meet their needs which even with the 0-care mandate tax, might be cheaper that purchasing HHS mandated insurance.
Inevitably, the Left will challenge these state laws on court, but that would take time and these plans could be shown to superior to the budget busting state exchange plans in the blue states.
If nothing is proposed by conservatives, this vacuum will be filled by the Left. They are starting right now by changing their nomenclature. Just wait, when we hear all the sob stories about middle class folks losing their insurance and “regular” people not being able to see the doctor, we will have the predictable cries for single payor, more Medicaid, and state exchanges. If nothing is done, we will be on the defensive again and lose.
The law of unintended consequences will work here. In states with no exchanges, there will also be no wage and price controls. Freedom allows innovation in an open marketplace.
We cannot imagine how the claims will be paid to work around Obamatron-care, but it will be, without having to resort to a black market at all. Just as business is flocking to right to work states, medical innovation will flock to those states which provide fertile ground for it to grow.