Based on widespread nonresponse from states that spent years fighting President Barack Obama's landmark health care reform law, the federal government will be involved in the new health insurance marketplaces called exchanges in more than two-thirds of the 50 states beginning in 2014.
The Obama administration had hoped opposing states would see that it's in their best interest to run their own exchanges as Congress intended after the U.S. Supreme Court upheld most of the Affordable Care Act last summer and the president's re-election effectively ended efforts to repeal Obamacare.
But even after the deadline to submit a plan was extended until Dec. 14, just 18 states and the District of Columbia had come forward to run their own exchanges, according to Kaiser's StateHealthFacts.org.
States face three exchange options: a state-run exchange; a federal-state partnership exchange; or a federally run exchange. All models are required by law to provide easy-to-use online shopping for affordable health insurance for small businesses and individuals, with open enrollment slated to begin next October.
Last week, Health and Human Services Secretary Kathleen Sebelius gave preliminary approval to Colorado, Connecticut, Maryland, Massachusetts, Oregon and Washington to create and run their own state-based exchanges, and conferred conditional approval upon New York and Kentucky. Other states already on board to run their own show include California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Utah and Vermont.
Other states now have until Feb. 15 to sign on for the federal-state partnership option. So far, seven states have partnership plans, including Arkansas, Delaware, Illinois, Iowa, Michigan, North Carolina and West Virginia.
According to media reports, Gary Cohen, who oversees the exchange project as director of the Center for Consumer Information and Insurance Oversight, says work is well under way on a customer service call center, interactive website capable of interfacing with each state's technology system, and a central data services hub that will determine an online applicant's eligibility.
The Congressional Budget Office estimates that 26 million people, including as many as half of the estimated 30 million uninsured Americans, will eventually be insured through the exchanges. Under health care reform, most Americans will be required to obtain health insurance or face a fine beginning in 2014.
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