SEARCH

Entries in State Exchanges (2)

Thursday
Dec132012

Health Care Deadline Looms: How States Are Setting Up the Exchanges

Kevin Lamarque-Pool/Getty Images(WASHINGTON) -- All of the Affordable Care Act, also known as "Obamacare," doesn't go into effect until 2014, but states are required to set up their own health care exchanges or leave it to the federal government to step in by next year. The deadline for the governors' decisions is Friday.

The health insurance exchanges are one of the key stipulations of the new health care law. They reportedly will offer consumers an Internet-based marketplace for purchasing private health insurance plans.

But the president's signature health care plan has become so fraught with politics that whether governors agreed to set up the exchanges has fallen mostly along party lines.

Such partisanship is largely symbolic because if a state opts not to set up the exchange, the Department of Health and Human Services will do it for them as part of the federal program. That would not likely be well-received by Republican governors, either, but the law forces each state's chief executive to make a decision one way or the other.

Here's what it looks like in all 50 states and the District of Columbia:

20 states that have opted out -- N.J., S.C., La., Wis., Ohio, Maine, Ala., Alaska, Ariz., Ga., Pa., Kan., Neb., N.H., N.D., Okla., S.D., Tenn., Texas and Wyo.

Several Republican governors have said they will not set up the exchanges, including Chris Christie (N.J.), Nikki Haley (S.C.), Bobby Jindal (La.), Scott Walker (Wis.), John Kasich (Ohio), Paul LePage (Maine), Robert Bentley (Ala.), Sean Parnell (Ark.), Jan Brewer (Ariz.), Nathan Deal (Ga.), Tom Corbett (Pa.), Sam Brownback (Kan.), Dave Heineman (Neb.), John Lynch (N.H.), Jack Dalrymple (N.D.), Mary Fallin (Okla.), Dennis Daugaard (S.D.), Bill Haslam (Tenn.), Rick Perry (Texas), and Matt Mead (Wyo.).

3 States Out, But a Little More Complicated -- Mont., Ind. and Mo.

The Montana outgoing and incoming governors are both Democrats, but the Republican state legislature rejected the Democratic state auditor's request to start setting up a state exchange. So a federal exchange will be set up in Montana as well.

The Indiana outgoing and incoming governors are both Republicans and outgoing Gov. Mitch Daniels deferred the decision to governor-elect and U.S. Rep. Mike Pence, who said his preference is not to set up a state health care exchange, paving the way for the feds to come in too.

In Missouri, Gov. Jay Nixon is a Democrat, but Prop E passed on Nov. 6, which barred his administration from creating a state-based exchange without a public vote or the approval of the state legislature. After the election, he sent a letter to the Department of Health and Human Services saying he would be unable to set up a state-based exchange, meaning the federal government would have to set up its own.

One State Waiting for the White House -- Utah

Utah already has a state exchange set up, a Web-based tool where small-business employees can shop and compare health insurance with contributions from their employee. In a letter Republican Gov. Gary Herbert sent to the White House Tuesday, he asked for its exchange, called Avenue H, to be approved as a state-based exchange under the Affordable Care Act as long as state officials can open it to individuals and larger businesses.

Norm Thurston, the state's health reform implementation coordinator, says authorities there, "haven't received an official response" from the White House, but, "we anticipate getting one soon."

19 State-Based Exchanges – Calif., Colo., Conn., Washington, D.C., Hawaii, Idaho, Iowa, Ky., Md., Mass., Minn., Miss., Nev., N.M., N.Y., Ore., R.I., Vt. and Wash.

Six Partnerships -- Ark, Del., Ill., Mich., N.C. and W.Va.

Two Undecided -- Va. and Fla.

That makes 23 states that will have federal exchanges, 19 states will have state-based exchanges (including the District of Columbia), six are planning on partnership exchanges between the federal government and the state, Utah is waiting on an answer from the federal government, and two states have not officially announced their decision: Virginia and Florida.

A representative for Virginia Gov. Bob McDonnell said an official announcement is likely to come Friday, but the Republican governor has repeatedly said he will likely reject the state-based exchange, paving the way for the federal government to come in.

Florida Gov. Rick Scott indicated last month that he was considering implementing a state-based exchange. He has made no official announcement either way and the Republican governor's office told ABC News they had no update on a decision, despite being a day away from the deadline.

Renee Landers, a professor of law at Suffolk University Law School in Boston who has written extensively on the new law, says if the remaining states don't make an official announcement by Friday, it's likely they will default to the federal exchange.

"If they don't decide to do it themselves, the default is the federal government will set it up," Landers said.

Landers boils down the decision by the nation's governors as this:

"If you want to wash your hands of [the ACA] as much as you can, entirely a federal exchange is your choice. But if you want as much control as possible, then the state exchange is the way to go; and the partnership, well every partnership is complicated," Landers said. "Sometimes it's nice to have the help, but on the other hand, you don't always get your way."

The Five Who Broke Party Lines:

Not all of the country's Republican governors rejected the state-based exchanges: Iowa Gov. Terry Branstad, Mississippi Gov. Phil Bryant, Idaho Governor Butch Otter, New Mexico Gov. Susana Martinez and Nevada Gov. Brian Sandoval all decided to assert more control over the plan and, despite some grumbling, will set up the state-based exchanges.

"If the state really believes in federalism and state control, then operating its own exchange is the best way," Landers said."Its appeal is that it relies on competition in the market for health care coverage instead of a public system."

Landers says the new law also tells states they can form inter-state compacts and run exchanges by region, though none of the states decided to so. But "the federal government, in areas where they have contiguous states with a lot of shared markets, you can see the federal government saying, 'We won't have two infrastructures for those states, we will have one,'" the professor said.

One example could be New Jersey and Pennsylvania, two states that will have federal exchanges and are next to each other.

"I think it's funny that governors who purportedly want to be in charge of their own fate don't want to be involved [in setting up the exchanges]," Landers said.

"But then they have no responsibility for things that go wrong and there will be things that go wrong, mistakes will be made and they will have deniability."

Copyright 2012 ABC News Radio

Thursday
Nov152012

Health Care Law: GOP Govs Opt Out of State Exchanges

Mark Wilson/Getty Images(WASHINGTON) -- Despite President Obama’s victory, Republican governors say they’re not caving in on carrying out the Affordable Care Act -- or as they’ve derisively dubbed it, “Obamacare.”

Several governors have announced that they would not up state health care exchanges from which residents can select a health care plan, a requirement of the signature piece of legislation from Obama’s first term, even though Obama’s re-election made the Affordable Care Act the law of the land and any refusal to set up the exchanges is largely symbolic.

States have until Nov. 16 to decide whether they will set up these exchanges, and this week several governors announced they’re opting out.

On Thursday, South Carolina governor and rising Republican star Nikki Haley sent a letter to the Department of Health and Human Services Secretary Kathleen Sebelius saying that South Carolina, “should not and will not set up a state-based health care exchange.”

Several other Republican governors, including Louisiana Gov. Bobby Jindal, a GOP leader who is frequently cited as a potential candidate in 2016, and Alabama Gov. Robert Bentley, announced that their states would also not set up an exchange.

“I am not going to set up a state-based exchange that will create a tax burden of up to $50 million on the people of Alabama,” Bentley said Tuesday.

Other states where the governors have made similar declarations include Kansas and Alaska. In Missouri, the Democratic governor announced on Thursday that the state would not set up an exchange either, but that announcement resulted from a ballot measure that forbade the governor from moving forward with an exchange without the approval of the state’s legislature, and Republicans control Missouri’s state legislature.

Wisconsin Gov. Scott Walker has said that he will make his announcement on Friday.

So what do these refusals mean for the future of the health care law? Not much, it seems, as the health insurance exchanges will be set up in these states anyway.

Under the law, if a state falls behind or opts not to set up the exchange, the federal government, specifically the Department of Health and Human Services, steps in and sets up the exchange. That would not likely be well-received by Republican governors either, but the law forces each state’s executive to make a decision one way or the other.

“If the state decides not to establish an exchange, then the federal government establishes the exchange for them. So it’s kind of a pick-your-poison scenario, if you will,” said Renee M. Landers, a professor of law at Suffolk University Law School in Boston.

The potential for state executives to opt out of this portion of the law had been anticipated for some time. Almost immediately after the Supreme Court announced its ruling on the Affordable Care Act last June, several governors, including Jindal and Walker, said they would wait until after the election to take any sort of action on the law.

Copyright 2012 ABC News Radio







ABC News Radio