WASHINGTON (AP) — Republican governors who've balked at creating the health insurance exchanges included in the Patient Protection and Affordable Care Act of 2010 (PPACA) may end up getting stuck with the very thing they're trying to avoid.
Unless Mitt Romney wins in November, states that haven't set up the exchanges, or Web-based health insurance supermarkets, could find Washington calling the shots on some insurance issues the states traditionally manage, from handling consumer complaints to regulating plans that will serve many citizens.
It could turn into a political debacle for those who dug in to fight what they decry as "Obamacare."
"You're kind of rolling the dice if you think [PPACA] will go away," said Kansas Insurance Commissioner Sandy Praeger, a Republican. If Romney can't make good on his vow to repeal the overhaul, "you are just giving up a lot of authority."
PPACA envisioned that states would run the new markets, called exchanges, with federal control as a fallback only. But the fallback now looks as if it will become the standard option in about half the states — at least initially.
It would happen through something called the federal exchange, humming along largely under the radar on a tight development schedule overseen by the U.S. Department of Health and Human Services (HHS).
The recent Supreme Court ruling upholding the constitutionality of a PPACA provision that lets the federal government tax many individuals who fail to have a minimum level of health coverage left both state exchanges and the federal option in place.
The exchanges are supposed to demystify the process of buying health insurance, allowing consumers to make apples-to-apples comparisons. Consumers will also be able to find out if they're eligible for new federal subsidies to help pay premiums, or if they qualify for expanded Medicaid.
It's all supposed to work in real time, or close to it, like online travel services. Open enrollment would start a little over a year from now, on Oct. 1, 2013, with coverage kicking in Jan. 1, 2014.
Eventually more than 25 million people are expected to get coverage through exchanges, including many who were previously uninsured. As exchanges get more customers, competition among insurance plans could help keep costs in check.
But only 14 states and the Districut of Columbia have adopted plans for their own exchanges. The states that have adopted plans are California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington and West Virginia. Some could still backtrack.
Kentucky and Minnesota are pushing forward with their own exchanges, and others may be able to partner with the federal government. States face a Jan. 1, 2013, deadline for Washington to sign off on their plans.
Meanwhile, the federal exchange is advancing.
HHS contractors are working feverishly to design and test computer systems that would make the federal exchange come alive. It's a top priority for the administration, which is guarding the details closely. Estimated price tag: at least $860 million.
The government is "on track in moving aggressively to set up this market structure," Mike Hash, the HHS official overseeing the effort, told industry representatives, state officials and public policy experts at a recent Bipartisan Policy Center conference. "We're on track … to go live in the fall of 2013."
