Now that the Supreme Court has ruled the reform law constitutional, attention turns to the states as to whether they will choose to implement and run their own health insurance exchanges or defer to the federally run exchange.
It's likely in insurers' best interest to sell plans through state-run exchanges because states' knowledge of their specific insurance markets will make the exchange more manageable. Therefore, it behooves insurers to work with their state lawmakers to help ensure they implement an exchange, particularly because one-third to one-half of all states could be running the federal exchange option, reported The New York Times.
Flying in the face of that goal, though, Republican lawmakers are urging states to reject health insurance exchanges, and several governors have publicly avowed not to create an exchange.
In a letter to all 50 states, Sen. Jim DeMint (R-S.C.) and Rep. Michele Bachmann, (R-Minn.) led 12 senators and representatives in calling for states not to establish an exchange.
"While Republicans in Congress will continue to push for a full repeal of Obamacare, the states can take immediate action to reject these exchanges that will increase healthcare costs and add more layers of bureaucratic red tape," Bachmann wrote in a statement accompanying the letter.
"These expensive, complex and intrusive exchanges impose a threat to the financial stability of our already-fragile state economies with no certainty of a limit to total enrollment numbers," the letter states. "Clearing the hurdles of crafting an exchange that complies with the 600-plus pages of federal exchange regulations will only result in wasted state resources and higher premiums for your constituents."
Perhaps the staunchest reform law critic, Gov. Rick Scott (R-Fla.) said he won't establish an exchange. "Florida is not going to implement Obamacare. We are not going to expand Medicaid, and we're not going to implement exchanges,'' Scott's spokesman Lane Wright said, adding that Scott will work to help repeal the reform law, NBC Miami reported.
And Gov. Nikki Haley (R-S.C.) said Monday that the state won't create an exchange because "states have little meaningful flexibility under the Obama administration's concept of state-based exchanges," the Times noted. Meanwhile, Gov. Chris Christie (R-N.J.) said he might let the federal government operate an exchange in the state, the Associated Press reported.
States must decide by November whether they're implementing their own exchange or deferring to the federally run option.