Tuesday, December 10, 2013
TOPEKA, Kan. — Kansas Insurance Commissioner Sandy Praeger has found herself at odds with Gov. Sam Brownback and other fellow Republicans over setting up an online system for consumers to comparison shop for health insurance.
This photo from Thursday, June 28 2012, shows Kansas Insurance Commissioner Sandy Praeger answering questions from reporters in Topeka, Kan., about the federal health care overhaul upheld by the U.S. Supreme Court. Praeger acknowledges that her opinion of the federal law is far more favorable than that of most Kansas Republicans. (AP Photo/John Hanna)
The federal health care law, which most Republicans deride as "Obamacare," requires states to set up so-called health insurance exchanges, which are described as a kind of Travelocity for health insurance. Praeger has praised the law as a "market-driven" step toward ensuring access to health care for all Americans.
That's a sharp contrast with the state's all-Republican delegation in Congress, which promised to redouble efforts to repeal the law after it was upheld by the U.S. Supreme Court last week. Brownback wants to delay setting up an exchange until after the presidential election, hoping a victory by GOP nominee Mitt Romney dooms the entire federal law.
As a result, Praeger often appears to be a faction of one in the Kansas GOP when it comes to health care issues.
"I'm by myself," she acknowledged last week.
The federal law gives states until Nov. 16 to submit their plans for setting up exchanges to the U.S. Department of Health and Human Services. Kansas hasn't done any work to create a plan because of strong opposition from GOP legislators and Brownback, who last year returned a $31.5 million grant to help finance the project. If states don't create their own exchanges, the federal government will run one for them.
Praeger said it's too late now to set up a completely state-run exchange, but Kansas could try to partner with the federal government, allowing the state to assist consumers and determine which companies can sell on the exchange. The federal law requires each state's exchange to be operating in 2014.
She questioned publicly whether a Romney victory would result in the law's demise.
Stephen McAllister, a University of Kansas law professor who once was a clerk for conservative Supreme Court Justice Clarence Thomas, shared her skepticism. He said Republicans would have to win the presidency, retain their U.S. House majority and capture a U.S. Senate majority to repeal the law.
"I'd be surprised — frankly shocked — if this got repealed," he said.
McAllister said that while Romney as president could alter anything left to the executive branch's discretion, he couldn't repeal some requirements without action by Congress.
"Waiting and waiting and waiting, and pretty soon 2014 is here," he said. "The obligation starts to kick in."
But Brownback is banking on a Romney victory leading to relief from the federal law's requirements, and he said last week that he'd expect Romney to issue a blanket waiver from the law for states upon taking office.
Furthermore, Brownback appears to lose little politically in Kansas by postponing decisions and casting the presidential race as a referendum on the health care overhaul. Republican lawmakers won't object, particularly after the party made big gains by framing the 2010 elections in that context.
That year, the GOP tapped the frustrations of the tea party movement and swept all statewide and congressional offices for the first time since 1964. It also added to its already sizeable legislative majorities.
Many of the new lawmakers were strong conservatives receptive to any state effort to thwart the federal law.
"The vast majority are against it," said Clay Barker, the state GOP's executive director. "There's a whole spectrum from, 'It's communism,' all the way to, 'It's bad public policy with a few good provisions.'"
The Kansas GOP has moved far to the right since Praeger, a 67-year-old moderate began her political career almost three decades ago with a stint on the Lawrence City Commission. Yet the same electorate that left state government significantly more conservative in 2010 also gave Praeger a third term as insurance commissioner.
"If you get elected, you have a legitimacy to go off on your own," said Burdett Loomis, a University of Kansas political scientist who spent a year working for Democratic Gov. Kathleen Sebelius, now Obama's health and human services secretary.
Last week, Praeger called the Supreme Court's ruling upholding the health care law "a first step in creating a health care system that works for all of our citizens." She's clearly no longer part of the GOP mainstream, and she's well aware of it.
"Yeah, it's a lonely place to be," she said.