Legislators frequently ask me what I mean when I write that implementation of a PPACA exchange means ceding control to Washington, DC along the lines of what they experience with Medicaid. Here’s an amusing story from Utah Gov. Gary Herbert to illustrate what that’s like.
So Herbert’s administration serves a Utah population which is both much younger and much more technologically adept than the average Medicaid population. Herbert decides that one way to achieve some minor but easily accessed savings is to shift to a paperless Medicaid system – to use email instead of mail. They commission a study and find that savings would run around $7 million a year – not huge, but probably worth doing. But even to do something this minor, Herbert has to receive approval from HHS and Kathleen Sebelius.
Herbert and his staffers begin the begging process, which all states must do in this situation, heading to DC on bended knee to request this small degree of flexibility. Utah even extrapolates the study out to the national scale, finding that if applied across the states, going paperless could save around $1 billion a year, which is approaching real money in Washington. They wait for an answer.
A couple of months later, Sebelius writes to tell Herbert that no, he may not go paperless, no permission is granted.
She wrote him via email.