More states finalizing exchange plans

Insurers are starting to get a clearer picture of which states will be implementing their own health insurance exchanges and which will default to the federal-run marketplaces.

As of Monday, 17 states and the District of Columbia have told the U.S. Department of Health & Human Services they will run their own exchanges. Another five states said they will establish "partnership" exchanges, in which states work with HHS to set up and run the marketplace, and 19 states will defer to the federal-run exchange, reported The Hill's Healthwatch.

Meanwhile, nine states remain undecided, including Arizona, Idaho, Montana, New Jersey, Oklahoma, Pennsylvania, Tennessee, West Virginia and Wisconsin, according to a State Reforum exchange map. All undecided states have until Dec. 14 to choose whether to pursue their own state-based exchange.

Some of the states technically fall into the "maybe" category, even though they've signed up to run their own exchange. Iowa, for example, will build an exchange, but only if HHS answers the 50 questions about how the marketplaces will be set up that Gov. Terry Branstad sent the agency, reported Kaiser Health News. "We continue to struggle with too many unanswered questions on topics critically important to the final development of an exchange that meets the needs of Iowans, including the cost of building and operating an exchange," he wrote.

But states aren't the only ones with concerns regarding exchanges. The National Association of Insurance Commissioners is drafting a working document of state queries about the exchanges it will present to HHS. As the agency responds to the questions, NAIC said it would post the answers within the document, KHN noted.

Meanwhile, Florida Gov. Rick Scott continued backtracking from his ardent opposition of a state-run exchange, saying he might consider building the marketplace if he can fund it without increasing health costs or state taxes, KHN reported. "I want to sit down and see if there is a way to do an exchange that reduced the cost of health care and improve access for the quality of health care, then I would be interested in doing it," he said.

To learn more:
- read the Kaiser Health News articles on Iowa and Florida
- check out The Hill's Healthwatch article
- see the State Reforum exchange map