Friday, February 15, is the final day for states to decide on their role in setting up the health insurance marketplaces required under the Affordable Care Act. The law gives state the choice to set up their own marketplace, partner with the federal government, or take no action and default to a federal government-run exchange. This is the last deadline until October, when the marketplaces are expected to open up for enrollment.
Despite the deadline, however, the Department of Health and Human Services (HHS) has shown flexibility on healthcare reform deadlines before, offering second, third, and fourth chances for states to choose to run their own marketplace for health insurance. Most recently, NAHAM News reported that HHS all but ignored deadlines in order to convince more states to take a part in setting up the marketplaces (States Will be Given Extra Time to Set Up Insurance Exchanges).
The decision on what to do with the marketplaces rests in the hands of state legislatures and governors, who don’t always see eye to eye. In New Jersey, for example, Politico reported that Governor Chris Christie (R) made it clear that he’s no fan of the healthcare law when he vetoed Democratic legislation that would have created an exchange. Virginia Governor Bob McDonnell (R) also rejected a fully state run exchange, but has recently said that he would sign legislation allowing the state to retain some control over the marketplace, similar to a partnership model.
Exchanges have long-term implications for the success of the healthcare law, not to mention political consequences for the governors and state legislatures that choose to either carry out the law or sit back while the federal government takes control.
As of now, according to a Kaiser Family Foundation tracker, 17 states have declared a state based exchange, 7 are planning a partnership exchange, and the remaining 26 would default to a federal exchange.