States prepare new push on exchanges post-SCOTUS decision -- or grind to a halt with confusion, opposition

From the states... reactions involving confusion, celebration or stiff opposition regarding the implementation of the health law's insurance exchanges -- despite affirmation of the overhaul's constitutionality by the Supreme Court Thursday.

Modern Healthcare: No Rush On Insurance Exchanges Expected In Red States
Some Republican governors had indicated they were waiting for the ruling before deciding whether to launch the insurance marketplaces required by the law. If states do not receive federal certification by the beginning of next year that they will have exchanges ready to launch by 2014, then the federal government will create an exchange in those states. At least one federal official has indicated that up to 30 states could have been waiting for either the court ruling or the November election before deciding to proceed with an exchange. Among Republicans who believe states will continue to wait for the outcome of the November elections was Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee (Daly and Zigmond, 6/28).

KQED: OK California, What The Health Exchange Means For You
There are the politics and the spinning. There's the talk of improved health outcomes … and then there is the bottom line. What does this mean for the state's consumers? The California Health Benefit Exchange is the most tangible institution that Californians will interact with as a result of the law. Those newly in the market to buy insurance because of ACA, this is your go to shop. Officials estimate that's around 3 million Californians (Dornhelm, 6/28).

Denver Post: Full Speed Ahead For Colorado Health Insurance Expansion
The Supreme Court's decision on upholding key provisions of the Affordable Care Act should speed insurance expansions to nearly all Coloradans, while opponents regroup for future fights, state officials and health experts said. The state will redouble efforts to prepare for 2014's growth in Medicaid enrollment, and a consumer "exchange" where other individuals should find affordable, uniform benefits, proponents said (Booth and Hoover, 6/29).

CT Mirror: Court Ruling Prompts Two Different Visions Of Connecticut's Future
The U.S. Supreme Court's landmark ruling Thursday conjured two distinctly different visions of Connecticut's future. For health care advocates and other supporters of President Obama's surviving health care reform, Connecticut dodged a bullet. For opponents, the Nutmeg State caught the bullet -- right between the eyes. On one side, the image includes a massive increase in Connecticut's insured population coupled with a huge infusion of federal dollars, both for state government and needy households. On the other, health care costs continue to grow unrestrained, while state government takes on a fiscal burden that ultimately will swamp its finances (Phaneuf, 6/28).

CT Mirror: Advocates Say State Can't Slow Down In Pursuit Of Health Care Reform
The ink had barely dried on national health care reform in May 2010 when Connecticut lawmakers adopted a plan to expand coverage for the poor. But while Connecticut has been ahead of the national curve in embracing the reforms, advocates warned that with Thursday's Supreme Court ruling, Connecticut's head start in pursuing federal health care dollars is over (Phaneuf, 6/28).

Minnesota Public Radio: Minnesota Officials Say They Will Press Ahead With New Health Care System
Gov. Mark Dayton's administration and state lawmakers have been preparing for life under President Barack Obama's health care law for some time. But their efforts got a new push Thursday when the U.S. Supreme Court upheld virtually all of the federal law. Several Republicans, however, are holding out hope the law can still be abolished. Minnesota's efforts to implement the Affordable Care Act have been a political tug-of-war so far, with Dayton aiming to enact its provisions while Republicans in the Legislature push back against him. (Scheck, 6/29).

MinnPost: Minnesota Moving Ahead With Health Insurance Exchange
Nothing in Thursday's U.S. Supreme Court ruling is expected to keep Minnesota from moving forward with its own health insurance exchange, according to key lawmakers, state officials and interest groups. Health insurance exchanges allow some uninsured individuals and small groups to shop for a variety of tailored health coverage plans. The exchanges, typically online, have been compared to travel websites like Orbitz or Expedia, and advocates say they will help lower coverage prices. Although about 15 states already have implemented exchanges, the issue has been extremely divisive in Minnesota. Gov. Mark Dayton's administration began preparations for an exchange in 2011 without input from the Republican legislative majorities (Nord, 6/28).

The Seattle Times: Washington State Took Steps To Be Ready For New Law
Some states, unenthusiastic about the federal health-care law and supportive of efforts to overturn it, dragged their heels on implementing its requirements. Not Washington. Betting on the come, the Democrat-controlled Legislature and policymakers here moved ahead, passing laws, applying for grants and hiring staff -- some of whom started work just weeks ago -- all in preparation for a federal law that was still in legal limbo. They could have looked really dumb (Ostrom, 6/28).

The Seattle Times: McKenna Accepts Health Care After Losing Law Suit He Was Part Of
Attorney General Rob McKenna split with many prominent Republicans in the wake of Thursday's Supreme Court ruling, saying Congress should not move to scrap the federal health care law or even its controversial individual insurance mandate. Although acknowledging disappointment in being on the losing side of the challenge to the Affordable Care Act, McKenna, the Republican gubernatorial candidate, said he's ready to implement its new health-insurance exchanges and Medicaid expansion if elected. "There are a number of good provisions in this law that ought to be maintained," McKenna said at a news conference in downtown Seattle. If some provisions "aren't workable" Congress should fix them, he said (Brunner, 6/28).

Detroit Free Press: How Health Ruling Will Change Care In Michigan
Thousands of Michigan residents -- many without health insurance for decades or with pre-existing conditions that excluded them from coverage -- won a major victory Thursday after the U.S. Supreme Court largely upheld the constitutionality of President Barack Obama's health care law. The justices, in a 5-4 decision, ruled that a controversial requirement that most Americans buy insurance by 2014 is constitutional under Congress' power to tax. That provision is the financial underpinning of the sweeping law, which aims to end inequities in health care coverage (Anstett and Spangler, 6/29).

Kansas Health Institute News: Kansas Has Small Window For Input On Health Insurance Exchange
In the wake of today's U.S. Supreme Court ruling, Kansas could still avoid ceding total control of its health insurance exchange to the federal government if it moves quickly, Insurance Commissioner Sandy Praeger said. "That's probably the best-case scenario now from an exchange standpoint," Praeger said. But that would require a meeting of the minds between Praeger and Gov. Sam Brownback and meeting a mid-November deadline for alerting federal officials to the state's intentions (McLean, 6/28).

Other state leaders still aren't sure how they should proceed with implementing the law, including the health insurance exchanges --

Miami Herald: Health Care Ruling Could Have Big Impact On South Florida
Several major South Florida health care leaders applauded the Supreme Court's decision Thursday on the Affordable Care Act because they say it will bring more access to the region's large number of uninsured and allow for providers to get paid for their care. But doctors leading the Miami-Dade and Broward medical associations said they're concerned whether physicians will be reimbursed enough under the new legislation. … The stakes are huge for the region's uninsured -- 31.8 percent of Miami-Dade residents, 24 percent in Broward and 32 percent in Monroe County, according to 2010 Census data. The national average is 16.3 percent. Among adults from 18 to 64, the potential effect is even greater: 57 percent of Hialeah residents in that age group are uninsured, 50.4 percent in the City of Miami, 48.5 percent in Deerfield Beach. Even in middle-class Kendall, almost one-third -; 31.2 percent -; of adults aged 18 to 64 now have no coverage (Dorschner, 6/28).

Miami Herald: Scott To Review Health Care Ruling Impact On Florida
The state that launched a two-year legal challenge to the federal health care law isn't sure what it will do now that the law has been upheld by the U.S. Supreme Court. Florida Gov. Rick Scott, who dipped into his personal fortune to campaign against passage of the health care law and, after being elected, refused to implement it, told reporters Thursday he would need time to decide his next move. "I've got to read through the decision and make sure we understand it," Scott said (Mitchell, 6/28).

Des Moines Register: Will The Iowa Legislature Need A Special Session To Deal With 'Obamacare'?
A special session of the Iowa Legislature won't be necessary to implement the new federal health care law – but only if Democrats and Republicans can work together in an informal setting, a Democratic state senator said today. State Sen. Jack Hatch, D-Des Moines, said he and Iowa Gov. Terry Branstad's chief of staff Jeff Boeyink have talked about a summit with others interested in health care. It would hopefully take place in the next two to four weeks, organized by a neutral group such as a hospital, he said (Jacobs, 6/28).

Milwaukee Journal Sentinel: Wisconsin Lags On Health Insurance Exchange
Thursday's U.S. Supreme Court ruling leaves Wisconsin without its own plan for setting up a key insurance marketplace called for under the health care law, and Gov. Scott Walker said he would not address that issue until at least November….The plan for the insurance marketplace, called an exchange, is due to the federal government in January 2013, and Walker's administration had announced late last year that it was stopping work on such a proposal until the Supreme Court had ruled. Now, Walker wants to wait longer, until after the fall election (Stein and Marley, 6/28).

In other state news -

Los Angeles Times: Health Insurance Rate Hike Measure Won't Be On November Ballot
A proposed voter initiative to require greater regulation of health insurance premiums in California has failed to qualify for the November ballot, according to the measure's author. Jamie Court, president of the Santa Monica advocacy group Consumer Watchdog, said he was told Thursday by the secretary of state's office that a spot check by county registrars of voters fell just short of the 555,236 signatures needed to go before voters in November's presidential election (Lifsher, 6/29).