HHS left with key task of setting up insurance exchange for more than half the states

More than 30 states are opting to not build the insurance marketplaces that are at the center of the health overhaul, so the job will be left to the federal government.

Los Angeles Times: Many States Leaving Insurance Exchanges To Federal Government
Despite years of prodding and pleading by the Obama administration, close to half of the nation's governors will not take a critical step to implement the president's health care law next year, leaving the job of running new insurance markets for their residents to the federal government (Levey, 12/14).

The Washington Post: Setup For States' Health Insurance Exchanges Is Massive Job With Crucial Deadline
Oregon's health insurance exchange needs a 150-person call center. Maryland's wants a public relations agency. And the Colorado exchange seeks something even more basic: a name. ... Officials in the states that did receive approval this past week to run their own health insurance exchanges describe the effort as a huge undertaking, with much work still to be done (Kliff, 12/15).

Kaiser Health News: Capsules: Facing Deadline, Most States Say No To Running Their Own Insurance Exchanges
The Obama administration will have to build and operate online health insurance markets for more than 30 states, something few expected when the federal health law was approved in 2010. ... Most experts thought only states with small populations such as Delaware or Montana would seek federal help. Instead, most will rely on the federal government -- including two of the most populous states, Texas and Florida, which together account for nearly 20 percent of nation's uninsured (Galewitz, 12/14).

CQ HealthBeat: As The Dust Settles, 18 States And The District Opt For A State Exchange
Iowa's Republican governor announced Friday that his state would pursue a partnership, though he said he also reserved the state's right to withdraw. In another development late Friday, Utah Gov. Gary Herbert said in a letter to HHS Secretary Kathleen Sebelius that he intends to ask her agency to certify Utah's existing state exchange as compliant with the health care law. While the exchange likely won't meet standards set in the law, and Herbert acknowledged it is "atypical," he also said it should serve as the minimum standard for all exchanges (Norman, 12/14).

CNN: Decision Day For States On Health Insurance Marketplaces
For most people, the decision won't mean much initially. Whatever states decide, consumers and small businesses in every state will have access to a health insurance exchange -- a place for people without work-based coverage to buy a policy. Analysts also say plans and costs will likely be fairly similar regardless of who runs the marketplaces, which are supposed to begin accepting enrollments in October (Pearson, 12/14).

Politico: GOP Governors Can Gum Up Health Care
Can the governors do what Congress, the Supreme Court and the election couldn't do -- drive out Obamacare? Some of the law's opponents certainly hope so. ... The reality is that the governors' rebellion won't deliver a knockout blow -- but it can throw a pretty large amount of sand in the gears. Supporters of the law and exchange experts say the Department of Health and Human Services has the capability to set up exchanges in as many states as it needs to. But the passive resistance of so many governors could gum up the works if the feds have to handle millions of enrollments, questions from confused customers and greater health plan oversight (Millman, 12/16).

The Hill: HHS Approves Three More State-Based Exchanges
The Department of Health and Human Services (HHS) issued conditional approvals for the District of Columbia, Kentucky and New York to run their own health insurance exchanges. HHS Secretary Kathleen Sebelius also approved six states on Monday: Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington (Viebeck, 12/14).

Politico Pro: Utah To HHS: We'll Stick With Our Exchange
Utah Gov. Gary Herbert asked the Obama administration late Friday to declare that the state's existing exchange meets Affordable Care Act standards, The Associated Press reports. The letter echoes Herbert's request from earlier this week, when he wrote to President Barack Obama asking him to order HHS to certify Utah's exchange and set it as the minimum standard for meeting the ACA. HHS Secretary Kathleen Sebelius responded on Friday, expressing the administration's desire to work with Utah to certify its existing exchange, the AP reported earlier (Millman, 12/14).

Minnesota Post: Minnesota Task Force Finalizes Plan For Implementing Federal Health Care Reform
A Dayton administration task force has finalized its recommendations for implementing federal health care reform and lowering Minnesota's increasing health care costs. The key goal, as Department of Human Services Commissioner Lucinda Jesson put it: "We just need more health for our dollar." Thursday's report, which will go to the Legislature and the governor, endorses work the Dayton administration already has undertaken to create a state-based health insurance exchange -- a key mechanism of the federal health care law -- and to expand Medicaid eligibility (Nord, 12/14).

MPR: Minn. Meets Deadline For Health Exchange
Minnesota is already ahead of the game. The insurance exchanges have been a politically charged topic around the country, as some Republican governors and legislatures have stalled or spurned the idea of building exchanges in their states. The exchanges will allow consumers to comparison shop for health insurance in online marketplaces. Minnesota submitted its plan to build an exchange last month. The next major task is to enact legislation authorizing an exchange in Minnesota. Lawmakers say they'll have a bill ready when the session begins in January (Stawicki, 12/14).

Meanwhile, states such as Arizona continue to weigh the decision about a Medicaid expansion --

The Associated Press: Options Fewer As Arizona Weighs Medicaid Decision
It's almost a case of starting over for Gov. Jan Brewer as she weighs whether to ask legislators to provide government-paid health coverage to hundreds of thousands of additional low-income Arizonans. A new Obama administration pronouncement eliminated a middle option that was seen as potentially palatable for Brewer and at least some cost-conscious majority Republican legislators (Davenport, 12/16).