New Health Care Poll Gives House Leverage To Demand National Health Care Exchange

Media pundits appear to be focused on President Obama's flagging approval numbers on health care. But last night's CBS poll on the health care debate is the latest evidence that America remains a center-left nation, and should give the House leverage to push for a key reform in the final congressional negotiations.

The President receives a scant 36% approval for his handling of health care, with disappointment from the Left dragging the number down: less than half of Democrats gave him a thumbs up.

More importantly, when CBS asked the ultimate ideological question -- does the bill regulate insurance companies too much, too little or about right -- only the right-wing fringe (27%) says the regulations on insurers "Go too far." The center-left majority says the bill regulates the industry too little or about right, with "Not far enough" winning the plurality of 43%.

As it so happens, there is an unresolved regulation issue between the House and Senate regarding the structure of the health insurance exchange, or marketplace for government-approved private insurance plans that will serve those currently uninsured and others: Will we have a national health insurance exchange or 50 state-run exchanges?

The insurance lobby is fighting the national exchange found in the House bill. Why? Jonathan Cohn explains:

Among the more compelling reasons to support a national exchange is a fear that individual states won't manage their exchanges aggressively enough--either because the people put in charge lack the expertise or the political officials overseeing them are in the pockets of the health care industry. (Believe it or not, industry lobbyists frequently have even more sway at the state level.) In addition, exchanges will likely be responsible for administering subsidies to people who need help buying insurance. But the subsidies will be coming from the federal government, which means states won't have as much incentive to manage the use of those subsidies wisely.

The best counter-argument to the national argument is that state officials would be in a better position to negotiate contracts, since they'll have a much sharper feel for the local markets and what works (or doesn't work) in each one. That might, in theory, allow the exchanges to bargain harder with insurers--or deliver better quality plans.

But that's not an argument against national exchanges so much as it is an argument for allowing states to opt out of the national exchange--and to take over management--once they've demonstrated ability to do the job on their own. And the House plan already includes such a provision, in part because one particular state (Massachusetts) already has a well-functioning exchange. You don't want to interfere too much with what's going on in Massachusetts--and you don't want to get in the way of other states that could similarly manage insurance on their own.

Understood properly, the House plan doesn't actually require all states to be part of the national exchange. It merely sets a high standard for what the exchanges should do--and allows states to handle the job as long as they can meet that standard. That's exactly how it should be.

A national exchange will be more able to get tough with insurers and set decent quality standards across the board.

The majority of the country wants strong regulation of the insurance industry.

A significant plurality is presently unconvinced.

Politicians would be wise to do something to convince them.

Views expressed on this page are those of the authors and not necessarily those of Campaign for America's Future or Institute for America's Future