Last Chance: States’ One Shot at Exchange Control Looms

Photograph by Andrew Harrer/Bloomberg

Demonstrators in favor of the Affordable Care Act hold up signs outside the Supreme Court building after the court’s ruling in Washington on June 28, 2012.

This week will be the last opportunity for states to retain some control over the new health insurance markets being readied for 2014 as part of the U.S. Affordable Care Act.

States still on the fence about building the exchanges for people to shop for subsidized health insurance must tell the Obama administration by Feb. 15 if they’ll at least join in a partnership with the federal government. The administration has said it will run exchanges for residents in states that refuse to build their own nor aid in the partnership.

It’s the latest deadline for governors grappling with full implementation of the 2010 federal health-care law, which relies on state cooperation to meet estimates of providing medical coverage to 27 million uninsured Americans. The government wants the state exchanges to be open for enrollment by Oct. 1 so residents can buy health plans that would take effect Jan. 1.

Just 16 states and Washington, D.C., are building their own exchanges, including three states led by Republicans — New Mexico, Nevada and Idaho. Utah Governor Gary Herbert said last week he would let the federal government build an exchange in his state, and the Obama administration on Feb. 8 rejected an application from Mississippi because that state’s insurance commissioner and governor weren’t on the same page.

Arkansas, Delaware, Illinois, Iowa and North Carolina have so far said that they’ll help the federal government run an exchange, a relationship the Obama administration calls a “partnership. The states take on some functions such as consumer assistance and approving health plans, while the federal government builds the website and other infrastructure.

North Carolina may back out; the state sent its partnership letter last year, before Republican Pat McCrory replaced Democrat Beverly Perdue as governor. The Republican-led legislature is considering a bill that would prohibit the state from helping to build an exchange.

 

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