States wrestle with health exchange decisions

Even as state officials decide whether they will set up online insurance markets or allow the Obama administration to do it for them, some wonder if the federal government is up to the task. Decisions about the health law's Medicaid expansion are also on governors' minds.

The Washington Post: Some Question Administration's Ability To Set Up State Insurance Exchanges
With a growing number of state leaders saying they will leave it to the federal government to handle a crucial element of President Obama's health-care law, even supporters of the statute are wondering if the administration is up to the job (Aizenman and Kliff, 11/13).

Los Angeles Times: California Works To Get Word Out On Health Insurance Exchange
Under the federal law, the state-run exchange aims to fundamentally reshape the health insurance market by negotiating with insurers for the best rates and assisting consumers in choosing a plan. The exchange must also help millions of Californians figure out whether they qualify for an expansion of Medicaid, the government insurance for the poor, or federally subsidized private coverage (Gorman and Terhune, 11/14).

Kaiser Health News: Nevada Quietly Moves Ahead On Health Law
Nevada has one of the highest rates of uninsured people in the nation – more than one in five Nevadans lack coverage. The state voted to reelect President Barack Obama by a margin of almost 7 points, but the president's health law has been as controversial in Nevada as it has been in most states led by a Republican governor. Nevada was one of the 27 states that challenged the constitutionality of the Affordable Care Act in court. But now Gov. Brian Sandoval is moving forward on a key part of the law (Bartolone, 11/13).

Kaiser Health News: Missouri, Kansas Reject State-Run Health Insurance Exchanges
Immediately after the presidential election, and more than a week ahead of the Nov. 16 deadline, Missouri Gov. Jay Nixon, a Democrat, announced he had made up his mind. The state would not be setting up its own health insurance exchange. Next door in Kansas, Gov. Sam Brownback, a Republican, made a similar announcement. These governors' moves open the door for increased federal involvement in health care in both states (Gordon, 11/13).

Kaiser Health News: Colorado's New Element In Exchange Plan: Certainty
More people with health insurance means fewer unpaid hospital bills, so it's no surprise hospitals like anything that makes it easier for people to get coverage. But in Colorado, even some Republicans who hate what they call Obamacare, support that the state is setting up its own health insurance exchange (Whitney, 11/14).

The Hill: Rick Scott Opens Door To Working With HHS On Insurance Exchange
Florida Gov. Rick Scott -; one of the most ardent Republican critics of President Obama's healthcare law -; might be backing down. Scott told the Associated Press on Tuesday that with the election over and the fate of "ObamaCare" secured, he's willing to at least consider taking some role in designing the state's insurance exchange. "The election is over and President Obama won," Scott said. "I'm responsible for the families of Florida ... If I can get to yes, I want to get to yes." That doesn't necessarily mean he'll end up at "yes" -; Scott, like other high-profile Republican governors, has been outspoken about what he sees as a law with excessive federal regulations. But even entertaining the idea of a state role in Florida's exchange is a sharp change in tone for the governor whose state led the legal challenge that ended up at the Supreme Court earlier this year (Baker, 11/14).

The Associated Press: Snyder, Lawmakers Discussing Health Care Exchange
Gov. Rick Snyder and legislative leaders are still discussing whether to establish a state market where people without health insurance could shop for private policies, officials said Tuesday. Under President Barack Obama's health care law, states have the option of running their own programs, letting the federal government do it or creating a partnership (Flesher, 11/13). 

The Associated Press: Choice Looms For Ariz Governor On Health Exchange
Gov. Jan Brewer is being pulled one way by major business groups and another by fellow conservatives as she faces a fast-approaching deadline to decide whether to implement a key part of the federal health care law. The decision, due Friday, will determine if Arizona creates a state-run, online marketplace for consumers to use when choosing health plans, or lets the federal government create and run a so-called "exchange" for the state (Davenport, 11/13).

The Associated Press: Haslam Remains Undecided On Insurance Exchange
Gov. Bill Haslam said Tuesday that part of the delay in deciding whether Tennessee will design its own health insurance exchange required under the new federal health care law is finding out how much flexibility the state would have. States have until Friday to inform the U.S. Department of Health and Human Services if they plan to set up their own health insurance markets (Johnson, 11/13).

The Associated Press: NJ Must Decide Soon On Health Insurance Exchange
The administration of Gov. Chris Christie is refusing to tip its hand on how New Jersey will respond to Friday's deadline to declare whether it will run its own health insurance exchange, let the federal government do it, or work together. The decision is the first major one states must make under the health insurance overhaul adopted in 2010 by Congress and signed by President Barack Obama (Santi, 11/13).

Politico Pro: Alabama: We Won't Build Exchange After All
After more than a year of planning for a state-based health insurance exchange, Alabama won't build its own after all, Gov. Robert Bentley announced Tuesday. Bentley also declared that Alabama won't expand Medicaid "under the current structure that exists because we simply cannot afford it." Though Bentley had put off a formal decision until the Supreme Court ruling and then last week's election, it's a sharp turnaround from June 2011, when he set up an exchange office and appointed an executive director to lead it (Millman, 11/13).  

The Hill:  Ala. Governor Rejects State Exchange, Medicaid Expansion
Another Republican governor on Tuesday formally refused to set up an insurance exchange under President Obama's healthcare law. Alabama Gov. Robert Bentley said the state will not establish an exchange and also will not participate in the law's Medicaid expansion. National conservatives are pressuring GOP governors to reject both exchanges and the Medicaid expansion, hoping to cause problems for "ObamaCare" by complicating the implementation process now that repeal is off the table. Bentley joins a handful of other GOP stalwarts who have said they won't proceed with either policy. Their approach comes with risks, though, namely by ensuring a far greater federal role in their states' healthcare systems (Baker, 11/13).

Minnesota Post: Minnesota's Health Exchange Path Gets Easier, But Still Lots To Do In A Little Time
Gov. Mark Dayton, who was using federal money and his executive authority to inch the exchange along -; as federal deadlines bear down -; now has friendly partners in the state to complete the exchange planning process. ... Exchange supporters say the service will affect about 1 million Minnesotans and will provide a competitive marketplace for individuals and small businesses to purchase insurance with a setup similar to travel websites like Travelocity. But much beyond the basics of what the exchange will look like and how it will function remain unknown. The federal government announced last week that it would extend a key Friday deadline to mid-December for states to submit blueprint proposals. By all indications, Minnesota will still signal to the feds this week that it intends to move forward with a state-based exchange and instead of a federally produced model. But the questions remain: Will Minnesota meet the ambitious deadlines outlined in the Affordable Care Act, and if it doesn't, how will the federal government react (Nord, 11/13)?

Milwaukee Journal Sentinel: 9 Lawmakers Want To Charge U.S. Officials Who Implement Obamacare
As Gov. Scott Walker contemplates whether to create a state health care exchange under Obamacare, he will have to contend in the coming legislative session with nine lawmakers who have said they back a bill to arrest any federal officials who try to implement the health care law. Rep. Chris Kapenga (R-Delafield) is one of the nine from Wisconsin who told the Campaign for Liberty he would back legislation to declare Obamacare illegal and allow police to arrest federal officials who take steps to implement it in Wisconsin. He said he believes the health care law is unconstitutional, despite the U.S. Supreme Court's ruling that it passes constitutional muster (Marley, 11/13).

Politico: Medicaid Expansion Decision Looms For Many States
Clues about governors' intentions for Medicaid expansion are beginning to seep out of tight-lipped state capitals, and it may be the start of a deluge. Most have kept silent until now, waiting for the presidential election to determine whether the Affordable Care Act -; and its optional Medicaid expansion -; would survive. But President Barack Obama's reelection, combined with looming budget deadlines in all of the indecisive states, could force their hands (Cheney and Smith, 11/14).