State decisions on health exchanges: Early indicators for Obamacare???s post-election health

Most political deadlines in recent years have been made to be broken. Nevertheless, state governors and legislatures are facing another one this week for the key building block of Obamacare. The Department of Health and Human Services (HHS) has set November 16 as the date for states to indicate more explicitly whether they plan to set up a ???state-based??? health benefits exchange in time for initial HHS approval by January 1, 2013. If so, they then must demonstrate sufficient implementation progress to be ready to go for operations one year later.

States??? other choices include cooperating with the federal government in implementing an exchange or leaving exchange operations entirely to Washington. But the basic decision comes down to: In or Out? Supine or Prone?

Since enactment of the Affordable Care Act (ACA) in 2010, many state officials have balked at participating in its model for ???state-run??? exchanges, which appeared to resemble part of a top-down bureaucratic plan to take more control of state insurance markets, rather than a less centralized, market-driven alternative. Several dozen state governors and state legislatures either opposed outright the creation of ACA-compliant exchanges or urged a cautious, go-slow approach to further implementation until more details were provided (or the Supreme Court decided to overturn the health law as unconstitutional). At this point, it still appears that a large majority of states will not meet the ACA???s initial deadline of January 1, 2013.

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Thomas Miller, a resident fellow at the American Enterprise Institute, is a former senior health economist for the Joint Economic Committee (JEC).