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Health Reform 2.0: States Balking at New Insurance Exchanges
Date:9/21/2012

By Karen Pallarito
HealthDay Reporter

First part of two-part series

WEDNESDAY, Sept. 19 (HealthDay News) -- Under the Affordable Care Act, the Obama administration's controversial reform of health care, states are supposed to assist uninsured Americans in buying health coverage by setting up so-called "insurance exchanges."

But, many states are dragging their heels on building the necessary infrastructure -- and some have outright refused to do so.

This lack of action poses a significant challenge to get the law up and running.

Continued Republican opposition to the 2010 law, the U.S. Supreme Court battle to determine its constitutionality, and ongoing uncertainty over the future of health reform after the upcoming presidential election have stymied progress on exchange development, policy experts say.

"The ACA (Affordable Care Act) cannot be implemented without an insurance exchange in each state. It's a go or it's a no-go. It's that simple," said Robert Laszewski, president of Health Policy and Strategy Associates Inc., an Alexandria, Va.-based consulting firm.

So far, only 15 states and the District of Columbia have established exchanges, and three others -- Arkansas, Delaware and Illinois -- have indicated that they will partner with the federal government to do it, according to the Henry J. Kaiser Family Foundation.

Creating insurance exchanges -- which are designed to make it easier for consumers to shop for insurance -- is just one of two big hurdles facing the health reform law. The Supreme Court ruling in June upholding the constitutionality of the Affordable Care Act also allows states to opt out of the law's Medicaid expansion provision -- a key piece in the drive to bring insurance to an estimated 30 million uninsured Americans.

Critics of "Obamacare" hope that state resistance on both fronts will stop the reform effort in its tracks.

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