States face Friday deadline on health exchanges

States must decide by Dec. 14 if they are going to operate their own health care marketplaces, or if they will defer to the federal government. They have until mid-February to decide whether to partner with the federal government or let the feds do it all. Meanwhile, polls in Missouri and Tennessee show public support for state-run markets.

Marketplace: States Must Make Health Care Decisions
It's decision time again in health care. No, not for you. States are making this one. Namely, whether they will operate their own health care exchanges or let the federal government do it. They've got til Friday to decide. Exchanges, you'll remember, are the online sites where small businesses and people who aren't insured at work, will be able to shop for health insurance starting in 2014. States? The fed? You may be wondering what difference it makes anyway. Well, here's one difference, says Georgetown professor Sabrina Corlette: power. "A state that's going to run its own exchange has an opportunity to really change the entire health care landscape if it wants to do that," she says. So for example, says Corlette, say a state has a big obesity problem. The state can make sureall the insurance plans on the exchange cover programs aimed at reducing obesity (Gorenstein, 12/12).

Politico Pro: Pennsylvania Governor: No-State-Based Exchange
Add the Keystone State's Republican governor to the list of those who have accepted federal funding to plan for a state-run insurance exchange, only to shut the door on it at the last minute. Pennsylvania Gov. Tom Corbett announced Wednesday that he will instead defer to the feds to establish an exchange for his state, arguing that the Obama administration hadn't provided enough details about how much authority the state would have. "With regulations still to be finalized and with more forthcoming, too many unknowns remain for us to plan accordingly," he wrote in a letter to HHS Secretary Kathleen Sebelius (Cheney, 12/12).

CQ HealthBeat: Idaho GOP Governor Says Yes To State Exchange, Nevada To Expand Medicaid
Idaho's Republican governor is a staunch opponent of the health care law but despite that C.L. "Butch" Otter says he will ask his legislature to approve a state-based health benefits exchange. Otter made clear in a statement that his decision doesn't mean he's had a change of heart about the health overhaul law. "This is not a battle of my choosing, but no one has fought harder against the mandates and overreaching federal authority of the Affordable Care Act,'' Otter said. (Bunis, 12/12).

MPR: Does Minnesota Need A Basic Health Plan?
When Minnesota lawmakers return to the Capitol in 2013, several health care-related matters await them, as the state moves to implement the federal Affordable Care Act by its 2014 deadline. The fate of MinnesotaCare - - the state-run health care program for low-income individuals and families -- is one of those issues. Under the Affordable Care Act, enrollees in MinnesotaCare will be among those eligible for tax credits that will help them purchase private insurance through online marketplaces called health care exchanges. The very creation of those exchanges is also a matter lawmakers will have to tackle next year. The debate also includes a question about people enrolled in MinnesotaCare who might not be able to afford private insurance, even with the tax credits. The state has the option under the ACA of creating what's called a Basic Health Plan. But many details about such a plan, including its cost, are still unknown (Weber, 12/13).

St. Louis Beacon: Most Missourians Favor Health Insurance Exchange, Expanding Medicaid, Poll Says
More than half of Missourians favor Medicaid expansion and embrace the principles behind health insurance exchanges, according to a new poll, financed by the Missouri Foundation for Health and completed in October. It surveyed more than 1,400 Missourians and had a margin of error of plus or minus 2.6 percent. "Missouri voters want action to ensure access to affordable health care and believe state government should take a leading role in this endeavor -- even if this requires a tax increase," according to the introduction to the poll (Joiner, 12/12).

The Associated Press/San Francisco Chronicle: Vandy Poll Shows Support For State-Run Exchange
A majority of Tennesseans -; including nearly three-quarters of those identifying themselves as Republicans -; prefer a state-run health insurance exchange over one run by the federal government, according to a poll released by Vanderbilt University on Wednesday. The poll of 829 registered voters showed 53 percent favor the state-run marketplace, while 33 percent prefer the federal approach. Seventy-two percent of Republicans surveyed said they support the state-based approach to the exchanges required under the federal health care law, compared with 31 percent of Democrats and 59 percent of independents (Schelzig, 12/12).