Sen. Alexander comes up with the wrong solution to the right problem.

In my latest piece for, I list seven reasons why other states should follow the District of Columbia's lead by requiring that all individual market healthcare policies be sold on the ACA exchange exclusively...along with, I also admit, three issues which would have to be dealt with in doing so.

By an amazing coincidence (or perhaps not...some of the problems I think would be fixed/mitigated by doing this are very much in the news at the moment), GOP Senator Lamar! Alexander of Tennessee has come up with his own related idea...which approaches these problems from the exact opposite perspective:

Alexander Bill Would Extend Subsidies to Off-Exchange Plans

Sen. Lamar Alexander is introducing a bill Wednesday that would extend Affordable Care Act subsidies to plans off of the exchanges for some eligible consumers.

The Tennessee Republican is proposing that states could opt to expand the Obamacare subsidies to plans sold off of the exchanges. For states without enough competition on the exchanges, governors could choose to have the subsidies to plans offered off the exchanges so consumers have more choice, he said.

...The bill would also waive the individual mandate for consumers in states where governors’ opted to extend the subsidies to plans outside of the exchanges.

This last part (waiving the mandate) makes no sense at all, outside of the GOP's general attempts to hack away at the ACA any way they can, of course.

However, the first part (extending APTC/CSR assistance to those who enroll in off-exchange ACA-compliant policies) does have some merit, in that it would indeed solve some of the same issues that moving all policies onto the exchange exclusively would.

However, Alexander's idea only solves the last two problems, while making the other five worse...and could cause additional headaches in the process.

As for the three downsides I list, Alexander's idea would admittedly avoid two of them...but the third would be just as much of an issue.

Aside from all of this: On the one hand, the main reason most people utilize HealthCare.Gov and the other state-based exchanges to enroll in individual health plans nowadays is because of the subsidies; if they don't qualify for them, they tend to enroll directly through the carrier, as I've noted many times before.

However, it's important to remember that another reason for the exchanges is to verify identities as well as qualifications for those subsidies. HealthCare.Gov's income verification process may not be perfect, but at least it's being handled by people who are legally allowed to access your IRS records and the like. Perhaps I'm being naive here, but I kind of assumed that Aetna, Humana, Blue Cross and so forth aren't supposed to have access to all of the federal info on you, which was among the reasons for handling the process via the exchanges in the first place.

I admit I was once opposed to doing this, back when there were major technical problems at and some of the other exchange platforms; why jump through all those extra hoops and red tape? Vermont, after all, tried doing just this but had to backtrack on the policy last fall due to ongoing technical problems.

That's the exception, however. HealthCare.Gov (which will be handling 39 states this fall) and (most) of the state exchanges are vastly improved these days; assuming they've streamlined the process to the point that it's no more (or only slightly messier) than enrolling directly through the carrier is, I think the time has come to strongly consider doing so. Unlike Vermont, the DC exchange has been handling 100% of DC's individual enrollments for 3 years running, and they seem to be doing just fine with it.

Anyway, read my seven reasons and decide for yourself.