States have until Nov. 16 to notify the U.S. Department of Health and Human Services (HHS) of their plans to create an exchange or partner with HHS to help create one. That gives states precious little time after the Nov. 6 election to submit plans and get an exchange up and running by October 2013.
"It looks like 35 states won't be ready, at least," Health Policy and Strategy Associates' Laszewski said.
The federal government insists that it's up to the task of working with states to ensure that the exchanges are in place by the deadline.
"We can guarantee that consumers in every state will have an exchange in place by 2014. There's no question about that," said Fabien Levy, HHS press secretary.
Laszewski isn't so sure. "The administration has been emphatic this last month that they will be ready, but they're not being at all transparent about it. We have no idea how much progress they have or haven't made," he said.
Although HHS issued a final rule on the design and implementation of insurance exchanges in March, many issues remain unresolved, explained Cristine Vogel, associate director in the Chicago health care office of Navigant Consulting Inc., a specialty global consulting firm. The unknowns range from how the government will resolve consumer appeals to how much it will cost states to use the federal exchange, she said.
Detractors, supporters debate exchanges' value
What do states gain by refusing to establish an exchange?
"We look at state refusal as one of the ways that states can protect themselves from the overreach of federal law," said Twila Brase, a registered nurse and president of the St. Paul, Minn.-based Citizens' Council for Health Freedom, which opposes the Affordable Care Act. One way the delay protects states, she said, is by avoiding the high cost of operating an exchange, estimated to run anywhere from $10 million to $100 million a year, dependin
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