WASHINGTON With the prospect of outright repeal all but gone, the nations health care overhaul is proceeding, and states that once resisted the politically divisive law now must decide what to do about the online insurance shopping malls known as exchanges.
Beginning next year, the law requires states to establish marketplaces where individuals can compare and purchase private insurance or, if eligible, enroll in Medicaid coverage.
States that want to run exchanges without federal involvement have until Friday to notify the Department of Health and Human Services, but they get until Dec. 14 to provide the details.
Idaho Gov. Butch Otter hasnt said what the state will do, but last month a task force told him to go with a nonprofit, state-based exchange rather than have the federal government administer the program.
Small businesses will use the exchanges to offer their employees a choice of coverage plans at group rates under the laws Small Business Health Options Program.
Federal tax credits tied to income will help many shoppers pay for coverage on the exchange. Further, competition among insurers and a groundswell of customers are expected to keep premiums in check when enrollment begins next October and coverage takes effect in January 2014.
The law requires all Americans to have health insurance in 2014 or pay a fine.
More than 9 million people are expected to get coverage through the exchanges in 2014, and 25 million in 2017, according to Avalere Health, a Washington consulting firm.
Many states that opposed the health care overhaul failed to prepare for the exchanges, hoping that a Mitt Romney presidential victory and a Republican takeover of the Senate would deal the law a death blow.
On Tuesday, Florida Gov. Rick Scott, a Republican and health law critic, said he was hoping to negotiate with the Obama administration after previously blocking all advance work on an exchange for his state.
The election is over and President Obama won, Scott said. Im responsible for the families of Florida. ... If I can get to yes, I want to get to yes.
States may operate and administer their exchanges themselves or in partnership with Health and Human Services.
Though the numbers might change, at least 14 states and the District of Columbia will have state-run exchanges, according to Avalere. California was the first state to pass legislation creating an exchange. The others include Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon and Washington.
States that run their own exchanges have the authority to make operational decisions on how theyll be built, who builds them and what health plans will be featured. In partnership exchanges, states divide operational and management responsibilities with the federal government.
Not every state is moving aggressively.
At least 11 that opposed the health care law probably will end up with federal insurance exchanges run entirely by Washington, D.C. Among them are Kansas, Missouri, South Carolina, Texas and Alaska, the only state not to accept $1 million in federal money to study building its own exchange.