Decisions regarding health insurance exchanges--whether states will operate their own or defer to the federal version--are rolling in now that the deadline has passed.
As of Friday's deadline, the U.S. Department of Health & Human Services had conditionally approved 20 states and the District of Columbia to set up their own exchange or partner with the federal government in an exchange. And more states were submitting their plans to HHS.
"My guess is we probably know what we're going to know about the state's decisions," Chas Roades, chief research officer for The Advisory Board Company told USA Today. "I think it's unlikely at this point that they'd raise their hands and say, 'We're going to participate.' "
Two states--New Hampshire and Illinois--opted for the partnership model. New Hampshire Gov. Maggie Hassan's legal counsel, Lucy Hodder, said partnering with HHS lets the state maintain authority over insurers, reported the New Hampshire Union Leader. "Right now if we don't tell the federal government what we want control over, we will lose it," she said. "We have lost a lot (of control) already."
Illinois, which already received conditional approval from HHS for its exchange, will continue regulating its insurance market and will assume responsibility for the exchange's customer assistance, including outreach efforts. HHS will build and operate the exchange, according to the Chicago Tribune.
Meanwhile, Virginia will be establishing its own state-run exchange, Gov. Robert McDonnell told HHS Thursday. Although Virginia will comply with the reform law's mandates, he said, "I remain vigilant in ensuring that Virginia will not bear the financial burden of establishing this new bureaucracy only to be given limited ability to manage its outcomes," The Washington Post reported.
And Ohio officials said the state would pass responsibility for creating and operating an exchange to HHS. Gov. John Kasich said he wants to preserve his authority over insurers that sell plans in and out of the exchange, but wants HHS to actually run the marketplace, reported the Cleveland Leader.