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Brownback folds on health care strategy

Published on -11/25/2012, 4:19 PM

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If Gov. Sam Brownback were a poker player, his opening bid would likely be all-in on every hand.

The governor is known as someone who rarely takes half-steps at anything. The tax changes passed in last year's legislative session and sweeping proposed changes to school funding, social services and state retirement accounts serve as more proof for anyone who needs it. Sometimes, that high opening bid ends up losing big money, and another all-in bet appears to be breaking away from the governor.

Brownback supported Mitt Romney's presidential bid, largely on the promise of an Obamacare/Affordable Care Act repeal as "Job One" of a Romney presidency. Romney lost, and now the state will have to implement some version of the state indemnity insurance plans mandated by the 2010 law. However, the governor previously has rejected more than $30 million in federal money to build the technological backbone for a state-federal cooperative health insurance program.

Having opted to not ante on one $31.5 million hand, which strategy would the governor take when it came down to the final hand on Kansas' role in the new health care environment?

States essentially have three options. They can establish their own exchanges using federal grants of the kind Gov. Brownback already has rejected. The governor already has exposed one of his tells there. Option two is for the state and the federal government to split the responsibilities. While states are on the hook for any money beyond the federal grant to the partnership, the state also gains a significant amount of freedom in the administration of their partnership. The third option is to fold the whole hand and let the federal government administer the entire program.

After so many aggressive bids, the governor has started playing very tight, opting for the third strategy of letting the federal government administer Kansas' entire health care exchange program. On the surface, the decision seems odd for a governor who believes states should serve as innovative laboratories for new public policy.

Insurance Commissioner Sandy Praeger thought as such when she expressed shock the state sent its $31.5 million check back to Washington in 2011. Praeger believed Kansas had the opportunity to set up a groundbreaking system that could serve as a cost-effective model for other states.

The governor disagreed, showing his hand and laying his strategy to passively protest the federal imposition through lack of participation.

The other entity whispering in Brownback's ear was Americans for Prosperity, his essential ally in the primary that wiped out most of the governor's in-house opposition. AFP press releases stressed the federal government's veto power over significant decisions made by the state in partnership and the fact states are required to pay any bills that go beyond the annual federal administration grants.

Looking at his hole cards, the governor decided it was best to fold and not play the game at all.

The decision to fold to the federal government is an odd one philosophically, if not economically. Gov. Brownback has pointed to the federal government as an example of how public policy is administered poorly, so effectively the governor has just ceded all control over a part of Kansas' health care to a government level he distrusts greatly. But just like in poker, money trumps all. At a time when the governor's stack of chips is dwindling quickly, any chance he has to slough more of his costs on to the federal government probably looks like a relief.

For someone used to betting aggressively, the governor suddenly has turned into a very conservative gambler.

Chapman Rackaway is an associate professor of political science at Fort Hays State University.

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