Others see state refusals on health exchange creation as little more than political posturing.
"I think they're taking a political gamble hoping that President Obama is [not reelected], and that is really putting all your money on one number," said Navigant's Vogel. "[They're saying] 'I did not support Obamacare at all.'"
Jon Kingsdale, managing director and co-founder of the Boston office of Wakely Consulting Group and former executive director of the state agency serving as Massachusetts' health insurance exchange, doesn't believe states will shut themselves out of the process of creating an exchange.
"My own sense is that even if the state backs completely away from doing the exchange, there'll still be some coordination" with the federal government, he said.
Even though many people would benefit from the tax credits and consumer assistance that exchanges will offer, exchange implementation, for the most part, isn't even on consumers' radar.
"I really doubt too many people even understand the health-care reform law and the exchanges," Vogel said.
The U.S. Department of Health and Human Services has more information on health insurance exchanges.
SOURCES: Robert Laszewski, president, Health Policy and Strategy Associates, Inc., Alexandria, Va.; Fabien Levy, press secretary, U.S. Department of Health and Human Services, Washington, D.C.; Twila Brase, R.N., president and co-founder, Citizens' Council for Health Freedom, St. Paul, Minn.; Cristine Vogel, associate director, health care practice, Navigant Consulting, Inc., Chicago; Jon Kingsdale, Ph.D., managing director and co-founder, Wakely Consulting Group, Boston, and former executive director, Commonwealth Health Insurance Connector Authority; Henry J. Kaiser Family Foundatio
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