States declare their health exchange intentions

A number of states notified the Department of Health and Human Services how they plan to proceed on the question of setting up an insurance exchange. News reports offer insights into the role political views and policy positions have played so far in the decision making.  

The Associated Press/Washington Post: States Deciding If They'll Help Carry Out A Key Component Of Obama's Health Care Overhaul
At issue is the creation of new health insurance markets, where millions of middle-class households and small businesses will shop for private coverage. The so-called exchanges will open for business Jan. 1, 2014, and most of their customers will be eligible for government subsidies to help pay premiums. The exchanges will also steer low-income people into expanded Medicaid programs, if states choose to broaden their safety net coverage (11/16).

The Associated Press/Washington Post: Grudging Acceptance Of 'Obamacare' Spreads As GOP-Led States Confront Implementation Choices
Associated Press reporters interviewed governors and state officials around the country, finding surprising openness to the changes in some cases. Opposition persists in others, and there is a widespread, urgent desire for answers on key unresolved details. Thursday evening, the Obama administration granted states a month's extension, until Dec. 14. A check by the AP found that 16 states remain in the undecided column (11/15).

National Journal: Republican Governors Happy With Sebelius Decision
Republican governors have spent two days bemoaning the Obama administration's deadline of Friday to decide whether to set up state-run health care exchanges or to allow the federal government to do it for them. But Health and Human Services Secretary Kathleen Sebelius's decision to push that deadline back to Dec. 14 gives governors more time to decide-;and a lot to celebrate. Sebelius pushed the deadline back after receiving a letter sent by Virginia Gov. Bob McDonnell, the outgoing chairman of the Republican Governors Association, and Louisiana Gov. Bobby Jindal, who was formally elected as McDonnell's successor on Thursday. The letter included 30 questions dealing with specific regulations to which the governors said they had not been provided answers. "There are many unanswered questions from HHS, from the administration, about the operation" about the Affordable Care Act, Jindal said on Wednesday. "We have not gotten meaningful answers. I think governors deserve those actions" (Wilson, 11/15).

CQ HealthBeat: More States Reach Decisions On Exchange Options
Leaders in Nebraska, North Carolina, South Carolina and Indiana on Thursday afternoon announced their decisions on what kind of health benefits exchanges they want in their states. Federal officials set Friday as the deadline for states to tell them if they plan to run their own marketplace. Nebraska Republican Gov. Dave Heineman said in a news conference that while he had first thought it would be better for Nebraska officials to control the exchange, he felt that the 2010 health care overhaul contained so many mandates that it left the state with little discretion about the details of the coverage in the exchange and the operational costs could be too costly. Heineman also confirmed that he would not expand Medicaid (Adams, 11/15).

Kaiser Health News: Capsules: Mississippi Builds Exchange Despite Objections Of Governor, Tea Party
The Mississippi Insurance Department officially told the federal government that it will run its own health insurance exchange and plans to file the exchange blueprint Friday. If the state had not set up an insurance exchange, which is an online marketplace for comparison shopping for health insurance called for by the health overhaul law, the federal government would have set one up in Mississippi instead (Hess, 11/16).

Houston Chronicle: Perry Says Texas Will Not Set Up Health-Insurance Exchange
A day before a Friday deadline, Gov. Rick Perry announced Texas would not set up a key component of the Affordable Care Act, a health-insurance exchange that would allow individuals and small businesses to find coverage online at the most favorable price. The governor reiterated his opposition in a letter released Thursday to U.S. Health and Human Services Secretary Kathleen Sebelius. "As long as the federal government has the ability to force unknown mandates and costs upon our citizens, while retaining the sole power in approving what an exchange looks like, the notion of a state exchange is merely an illusion," Perry said in the letter (Holley, 11/15).

The Associated Press/The Dallas Morning News: Gov. Rick Perry Officially Refuses To Set Up Affordable Care Act Insurance Exchange For Texas
Texas Gov. Rick Perry officially notified the federal government on Thursday that the state will not set up an exchange to help people buy health insurance. Perry sent the letter to Health and Human Services Secretary Kathleen Sebelius a day before the deadline to let Washington know that the state will not set up its own exchange. President Barack Obama's administration gave states the option of setting up their own exchanges, partnering with the federal government or letting Washington do it (Tomlinson, 11/15).

The Associated Press: Arizona Governor Jan Brewer Postpones Health Care Act Decision
Arizona Gov. Jan Brewer is postponing when she'll declare whether Arizona will create a state-run insurance exchange as part of implementing the federal health law that she opposes. Brewer's office disclosed the postponement on the hot-potato issue late Thursday after the federal Department of Health and Human Services extended until mid-December a deadline for states to make exchange declarations (11/15).

The Associated Press: ND GOP Leader Rethinking Options On Health Care Law, Administration Possible
North Dakota's House Republican majority leader says the Legislature may revisit whether the state should take part in running a new health insurance marketplace that is a key part of the new federal health care law. Lawmakers rebuffed a proposal for a state-run "health exchange" a year ago, when many Republicans hoped the U.S. Supreme Court would throw out the law -; or that this year's elections would lend momentum to efforts to repeal it (Wetzel, 11/15).

The Associated Press: Alaska Gov Again Rejects State-Run Health Exchange
Alaska is not one of the states that will be setting up a state-run health insurance exchange under the federal health care law. Gov. Sean Parnell made his intention clear in July, saying "federally mandated programs should be paid for by federal dollars" (Bohrer, 11/15).

Anchorage Daily News/McClatchy: Alaska Rejects State-Run Health Insurance Exchange
Gov. Sean Parnell announced in July that Alaska would not create a state-run health insurance exchange, and he is sticking by that, Parnell spokeswoman Sharon Leighow said Tuesday (Shinohara, 11/15).

The Associated Press: Haley Reaffirms No To Health Exchange
Gov. Nikki Haley told the federal government Thursday that South Carolina won't set up a state health exchange, saying President Barack Obama's re-election did not change her stance. In a letter to Health and Human Services Secretary Kathleen Sebelius, Haley says the exchanges called for under the federal health care law known as Obamacare are state-based in name only (Adcox, 11/16).

The Associated Press: NC Officials Opt For Online Health Insurance Market As State-Federal Hybrid, Seek Fed Funds
North Carolina and the federal government will jointly run a new one-stop shop to help people buy affordable health insurance, Gov. Beverly Perdue said Thursday. Perdue, a Democrat, said she consulted with Gov.-elect Pat McCrory, a Republican, and chose a state-federal partnership to operate the health insurance exchange required by the Affordable Care Act (Dalesio, 11/15). 

Milwaukee Journal Sentinel: Wisconsin Unlikely To Create Health Care Exchange
Gov. Scott Walker signaled Wednesday that Wisconsin likely won't move forward with creating its own online insurance marketplace as called for under President Barack Obama's health care overhaul, leaving that to the federal government. The Republican governor's decision on the insurance exchange, scheduled to be announced Friday morning, has big potential implications for the state's patients, the health care sector and Walker's own political career. An odd coalition of business groups, health insurers and Democrats has pressed Walker, an opponent of the Affordable Care Act that is often called Obamacare, to set up state exchanges where small businesses and individuals could buy health insurance (Stein and Boulton, 11/15).