Today is deciding time for states on health exchanges

The Associated Press reports that 19 states have turned down the idea of running health insurance exchanges, creating a daunting task for the federal government.

The Associated Press: Time For States To Decide On Health Care Exchanges
Nineteen states have turned down the Obama administration's invitation to run the new health insurance markets that will begin serving millions of uninsured Americans less than a year from now. That puts a huge task on the feds, a defining challenge for President Barack Obama's second term. ... On the other side of the ledger, 17 states and Washington, D.C., say they want to set up and run their own markets. The administration has already started granting approvals. Eight other states have indicated they want to pursue a partnership with Washington, and more may do so. Only six remain undecided (Alonso-Zaldivar, 12/13).

Reuters: U.S. Faces Task Of Running Dozens Of Health Exchanges
On the eve of a federal deadline for states to say whether they will run their own exchanges, a top U.S. healthcare policy official told lawmakers that the exchanges will start enrolling eligible families starting on October 1, 2013 (Morgan, 12/13).

NBC News: Vitals: Feds Look Set To Run Most State Health Insurance Changes
Two-thirds of Americans who sign on to buy health insurance using new state marketplaces will actually be getting a federally administered plan, a health consultancy firm projected Thursday. ... Friday is the deadline for states to say for sure what they plan to do and just three states – Florida, North Dakota and Indiana – have failed to give an answer so far. But all three have governors who have indicated they won't be setting up exchanges (Fox, 12/13).

The Hill: Analysis: Feds Will Have Outsize Role In Health Exchanges
Most people buying coverage on the Affordable Care Act's exchanges will be working through a system run by the federal government, according to a new analysis. Consulting firm Avalere Health estimated Thursday that two-thirds of people likely to purchase coverage on the marketplaces will buy through a federally administered or "partnership" exchange. This trend means that "key federal decisions about plan participation, the consumer interface and outreach activities, eligibility and enrollment, and options for small businesses will have a crucial impact on individuals' experiences with the exchanges," Avalere wrote (Viebeck, 12/13).

Politico Pro: Avalere: Two-Thirds Of Exchange Enrollment Will Be Federally Administered
Almost two-thirds of those who buy insurance via an exchange in 2014 will do so in one that has significant federal involvement, Avalere Health predicted Thursday. On the eve of the latest exchange decision deadline for states, Avalere's estimates find that federally run exchanges and partnership exchanges will end up dominating the landscape. Of the 8.2 million people who are expected to buy insurance through an exchange in 2014, the health consulting firm estimates that just 2.8 million will buy it through a state-based exchange. Avalere said that as of Thursday, 17 states plus the District of Columbia have committed to a state-based exchange, and Utah is still waiting to see if the Obama administration will approve its state-based model (Smith, 12/13).

The Washington Post: GOP State Leaders Fumble By Ceding Control Of Health Exchanges To Federal Officials, Critics Say
Republicans frequently denounce the health-care law as a dangerous overreach of federal power. But now Washington's role is expanding, and some conservatives charge that Republicans have only themselves to blame. The vast majority of Republican-led states, faced with a Friday deadline to submit plans for running the insurance exchanges at the heart of the law, have opted instead to relinquish much or all of their control to the federal government (Aizenman, 12/13).

National Journal: Health Exchanges A Tough Sell With Many States
In hopes of encouraging reluctant states to embrace the new health care law, the Obama administration has extended their deadlines to commit to running new insurance marketplaces and published answers to states' biggest questions. But most states will probably still decide to sit on the sidelines. President Obama's signature health law was designed around the notion that new access to health insurance for individuals and small businesses would be crafted in partnership with state governments, which have traditionally regulated their own insurance products. The federal government would perform some functions, but leave many details to the states. The idea is to have the new online marketplaces, known as exchanges, up and running by late 2013 to allow the new insurance coverage to begin in 2014. Friday is the final deadline for states that wish to run their own exchanges to submit their plans (Sanger-Katz, 12/13).

Bloomberg: Republicans Seek Delay Of Obama Rules On U.S. Health Law
Senator Orrin Hatch and nine other Republicans asked for a delay of new U.S. rules for health-insurance exchanges and other parts of the Affordable Care Act, saying the public isn't being given enough time to comment. The 30-day comment period on the regulations makes it "extremely burdensome, if not nearly impossible, to formulate an accurate and instructive response," the senators said in a letter today to the U.S. health, treasury and labor secretaries. The period should be extended to at least 60 days, they said (Wayne, 12/13).

Modern Healthcare: CMS Won't Delay On Insurance Exchange Rules
A senior CMS official rejected a call by Republican senators to extend the comment period for rules governing coming health insurance exchanges. Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the CMS, told reporters Thursday that he would not consider extending the comments period for various exchange rules and delaying their finalization. "There's not a lot of time between now and October, and people are saying that we need to get these rules; the industry in particular is saying 'We need to get these rules finalized in order to know how to develop plans and get them into states,'" Cohen said. … The senators requested extensions of the comment periods for an essential health benefits rule; health insurance market rules; and the HHS notice of benefit and payment parameters for 2014. The comment periods for the rules end later in this month (Daly, 12/13).

And on the Medicaid expansion front -

The Associated Press/Washington Post: After Campaigning Against Federal Health Care Law, Ark. Republicans Weigh Medicaid Expansion
Like their counterparts in other southern states, Arkansas Republicans denounced "Obamacare" during this year's election campaign and called for its repeal. But now that they've won control of the Legislature for the first time in 138 years, GOP lawmakers are considering something that would be anathema to conservatives elsewhere -- expanding government health care in the state (12/13).