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States Begin Announcing Their Choices for Obamacare Implementation: Fed vs. State Control of Insurance Exchanges
WASHINGTON (TheBlaze/AP) — After two years of political battles and a Supreme Court case, many if not most states are expected to tell the federal government Friday if they’re willing carry out a key part of President Barack Obama’s health care overhaul.
At issue is the creation of new health insurance markets, where millions of middle-class households and small businesses will shop for private coverage. The so-called exchanges will open for business Jan. 1, 2014, and most of their customers will be eligible for government subsidies to help pay premiums. The exchanges will also steer low-income people into expanded Medicaid programs, if states choose to broaden their safety net coverage.
Thursday evening, the Obama administration responded to a request for more time from Republican governors by granting states a month’s extension, until Dec. 14.
Ahead of the original deadline, a check by The Associated Press found that 21 states plus the District of Columbia, have already indicated they want to become involved, either by building and running their own exchanges or partnering with Washington. The 16 that want to build their own exchanges, plus the District of Columbia, face a Jan. 1 deadline for the federal government to approve their plans.
Photo Credit: AP
This group of 16 includes mainly Democratic-led states such as California and New York, but also some Republican-led ones such as Mississippi and New Mexico.
Five other states have signaled they want to partner with the federal government. Those states would handle consumer issues and oversight of health plans in the exchanges, while the feds do the heavy lifting by enrolling individuals for coverage and determining who’s eligible for government assistance. Among these states are Arkansas and North Carolina.
The number of partnership states could grow significantly, since the Obama administration has given states until next February to decide on that option. As of Thursday, 16 states indicated that they were weighing their options and have not made a final decision.
Among those, Ohio and Tennessee were considering the partnership route. And in Florida, Republican Gov. Rick Scott is now saying he wants to find a way to work with the federal government after years of steadfastly opposing Obama’s overhaul.
Finally, 13 states have indicated they will default to the federal government, allowing Washington to set up and run their exchanges. The health care law provided that the feds would run exchanges in states that were not ready or willing to do so. In this group are states whose Republican governors have staunchly opposed the law, including Texas, Louisiana and South Carolina.
Obama’s election victory guaranteed the survival of his health care law, which is eventually expected to provide coverage to more than 30 million people through the exchanges and expanded Medicaid programs. It was the final hurdle, after the Supreme Court upheld a legal challenge from 26 states. In the aftermath of the election, some Republican state leaders say it’s time to accept the law.
“I don’t like it; I would not vote for it; I think it needs to be repealed. But it is the law,” said Mississippi Insurance Commissioner Mike Chaney, after announcing that his state wants to set up its own exchange. “If you default to the federal government, you forever give the keys to the state’s health insurance market to the federal government.”
Traditionally, states have regulated the private health insurance market.
But other Republican-led states say they don’t have enough information to make a decision at this point and are clamoring for the Obama administration to release major regulations that have been bottled up for months.
“States are struggling with many unanswered questions and are not able to make comprehensive far-reaching decisions prudently,” Govs. Bob McDonnell of Virginia and Bobby Jindal of Louisiana wrote Obama earlier this week. They asked for a meeting with the president, as well as a postponement of the original Nov. 16 deadline.
Some of their main concerns are hidden costs of operating the exchanges and the sheer bureaucratic complexity of the new system. The Obama administration has steadfastly maintained it will not postpone the Jan. 1, 2014, launch date for the law’s coverage expansion. Open enrollment for exchange plans will begin even sooner, Oct. 1, 2013.
Policy experts in Washington are noticing the shift.
“I think it’s a very practical decision for states now,” said Alan Weil, executive director of the nonpartisan National Academy for State Health Policy. “We are going to have a significant number of states running their own exchanges, a significant number where the federal government is running the exchange and a significant number of partnerships. The bottom line is, we are going to have to figure out how to make all three models work.”
Although the public remains divided about the health care law, the idea of states running the new insurance markets is popular, especially with Republicans and political independents. A recent AP poll found that 63 percent of Americans would prefer states to run the exchanges, with 32 percent favoring federal control.
The breakdown among Republicans was 81 percent to 17 percent in favor of state control, while independents lined up 65-28 for states taking the lead. Democrats were almost evenly divided, with a slim majority favoring state control. Below, find a list of states, their current decision for managing the health care system and the number of people who are uninsured within each:
| Alabama Federal exchange 696,000 |
| Alaska Federal exchange 128,000 |
| Arizona Decision pending 1,306,000 |
| Arkansas Federal-state partnership 545,000 |
| California State exchange 7,471,000 |
| Colorado State exchange 817,000 |
| Connecticut State exchange 391,000 |
| Delaware Federal-state partnership 115,000 |
| Washington, D.C. State exchange 65,000 |
| Florida Decision pending 3,952,000 |
| Georgia Decision pending 1,992,000 |
| Hawaii State exchange 102,000 |
| Idaho Decision pending 239,000 |
| Illinois Federal-state partnership 1,795,000 |
| Indiana Decision pending 856,000 |
| Iowa Decision pending 292,000 |
| Kansas Federal exchange 361,000 |
| Kentucky State exchange 727,000 |
| Louisiana Federal exchange 811,000 |
| Maine Federal exchange 146,000 |
| Maryland State exchange 734,000 |
| Massachusetts State exchange 215,000 |
| Michigan Federal-state partnership 1,336,000 |
| Minnesota State exchange 453,000 |
| Mississippi State exchange 530,000 |
| Missouri Federal exchange 780,000 |
| Montana Decision pending 179,000 |
| Nebraska Decision pending 226,000 |
| Nevada State exchange 555,000 |
| New Hampshire Federal exchange 136,000 |
| New Jersey Decision pending 1,334,000 |
| New Mexico State exchange 506,000 |
| New York State exchange 2,780,000 |
| North Carolina Federal-statePartnership 1,583,000 |
| North Dakota Decision pending 74,000 |
| Ohio Decision pending 1,578,000 |
| Oklahoma Federal exchange 597,000 |
| Oregon State exchange 678,000 |
| Pennsylvania Decision pending 1,319,000 |
| Rhode Island State exchange 122,000 |
| South Carolina Federal exchange 754,000 |
| South Dakota Federal exchange 108,000 |
| Tennessee Decision pending 982,000 |
| Texas Federal exchange 6,654,000 |
| Utah Decision pending 424,000 |
| Vermont State exchange 61,000 |
| Virginia Federal exchange 1,023,000 |
| Washington State exchange 812,000 |
| West Virginia Decision pending 266,000 |
| Wisconsin Decision pending 562,000 |
| Wyoming Federal exchange 84,000 |
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Comments (56)
revelation2012
Posted on November 16, 2012 at 1:29pmhow do they know how many are uninsured
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MrArbitrage
Posted on November 16, 2012 at 1:10pmWar on Papa John Threatens Obama’s Fast Food Based Recovery
http://youtu.be/OnjPJiaXC4A
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rickc34
Posted on November 17, 2012 at 12:31amThanks for the video. Yep Obama blew it and is so full of himself he can’t see it.
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Dismayed Veteran
Posted on November 16, 2012 at 11:58amI work for a company that is on a waiver. Sounds good doesn’t it. Just to let you know what you are facing: Annual surgical coverage: $1000 after deductible. My wife broke her wrist in January. The total bill because she needed surgery is $14,000.
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Halloween
Posted on November 16, 2012 at 12:51pmSounds good that you only had to pay the $1,000 deductible for your insurance to cover the $14,000 surgery. If it was Obama care you would have to wait and maybe they would not even do the surgery.
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cloberto
Posted on November 16, 2012 at 1:53pm@Halloween.
You misunderstood the original poster. HE was responsible for $14000 because the insurance they had only covered $1000 after deductible. So he had to pay cost of surgery minus the deductible minus the covered $1000. That total equaled $14000. @Dismayed Veteran, please correct my if I am wrong.
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Dismayed Veteran
Posted on November 16, 2012 at 11:52amNebraska announced today. We are going federal.
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brandonvphoto
Posted on November 16, 2012 at 11:05amHere in Utah, I heard one of our state reps on the radio yesterday. He said they (the state legislators) have no idea what to do. The federal government has not given them the information they were supposed to to make the decision. So in essence they have no idea so they guessed what would be best essentially.
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mtcountrygrl
Posted on November 16, 2012 at 11:29amIf the states say no, the bill falls apart. There is no funding in the bill to set up and run the exchanges. The enforcement of the employer mandates and the issuing of the health care subsidies was supposed to be done by these exchanges and the costs picked up by the state budgets. Estimated costs to run state exchanges are in the 100′s of millions per year.
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notworkingafter2009
Posted on November 16, 2012 at 10:48amProtect your own! Sorry for all the dead people in the streets! But that is what the Globle Government wants, Thin the hurd!!!
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wordsofwisdom
Posted on November 16, 2012 at 10:46amWelcome to third world medical care! This is a sad time in history. We are witness to the destruction of medical advances and research that could cure horrible diseases. Makes me sich just thinking what we are throwing away. Hey pres. the lack of medical discovery will impact your family some day as well so I hope you are happy!
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TheePolitinator
Posted on November 16, 2012 at 11:05amNo it will have no impact. Because our elected have cadillac health care plans still. They do not themselves have to use these exchanges. And we pay for their cadillac care.
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matinva
Posted on November 16, 2012 at 10:28amAmericans are going to find out before long that they’ve (we’ve) been screwed by the Democrapheads. This is the ultimate in income redistribution. It doesn’t matter what costs go up. They will all get passed right on down to the end user one way or another.
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Watcher1952
Posted on November 16, 2012 at 9:53amMore of the PASS IT BEFORE YOU FIND OUT WHAT’S IN IT……Americans will find in the future that this is an extremely bad controlling idea……
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HKS
Posted on November 16, 2012 at 9:08amRomney was almost right, that 47% is really over 50%, the country has hit the tipping point of government dependence. Those people are certainly not going to vote for anyone that’s going to take away their free ****. With that said the only solution is let it burn.
“Remember Benghazi”
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progressiveslayer
Posted on November 16, 2012 at 8:59amVA health care for all is what this is and you’re not going to like it one bit but you simpletons voted for it now the rest of us are going to have to suffer for it. I was in the VA hospital in Cleveland many years ago and it was a hell hole then,filled with people who can’t be fired so they can get away with anything they want.The libs complain about health insurance companies denying claims lol the government will show those soon to be extinct companies how to deny claims the right way,millions will be denied because of the obvious,we’re broke.
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WTF
Posted on November 16, 2012 at 9:27amAnd they’ll probably sit on a referal you need until after you’re dead
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Snuph
Posted on November 16, 2012 at 8:55amThe states need to say no. If they let the feds do it 2 good things happen for the state. One the state is not liable for the costs, two the state employers are exempt from the employer mandate. The down side is the people are ineligible for any federal assistance.
The state exchange is designed to force the states to cover half the costs. It will bankrupt each and every state that does it.
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lisa61
Posted on November 16, 2012 at 8:55amname ONE Gov Controlled ‘business’ that works !
We have to let it crumble in order to restore it.. sadly ..
will some states, by their choices , be magnets for current freeloaders ??
just wondering.. my state is still Pending..
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getourcountryback
Posted on November 16, 2012 at 8:45amWell, the stupid azz people voted to put this jackstick back in office so if they now get crappy healthcare for free they should be happy, right? Better than getting great healthcare for free, right? They can only get this stuff until the money runs out and that is coming in short order. Maybe when they start dying off things will get better.
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marybethelizabeth
Posted on November 16, 2012 at 8:38amOf course the state money grabbers want control.
Much more corruption can occur at the State level.
It’s probably cheaper to have the “kickback”, er, fee, paid once to the Feds that to each state individually.
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Rothbardian_in_the_Cleve
Posted on November 16, 2012 at 8:45amLOL. Now you’re not even trying. I’m sure the people paying you are not happy with that post. It isn’t even thinly veiled trolling. That is just stupid and not what they are paying you for.
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The_Cabrito_Goat
Posted on November 16, 2012 at 11:06amThey need to increase her salary, from a dime a post, to a quarter. As far as annoying trolls go (there are many different kinds) Mary is one of the best. Because she never, ever shuts up.
It’s astounding how straight-faced she can seem while replying in her contrarian style to solid facts, distorting them, or just thumbing her nose at universally accepted evidence.
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hunter1riley
Posted on November 16, 2012 at 8:33amWTH is an exchange? I can’t figure out anything about this stupid law except it is going to screw up my health care and it’s already costing me more. I really despise government interference.
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ferggie
Posted on November 16, 2012 at 8:30amThe house is full of a bunch of gutless b@$1ard$. Why don’t you losers start defunding these programs and quit blamming the left. You own the checkbook, start cutting or we start cutting more heads in the next election.
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madvlad
Posted on November 16, 2012 at 1:54pmRight on!
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Rothbardian_in_the_Cleve
Posted on November 16, 2012 at 8:02amYou guys have it all wrong. Embrace it. Welcome it. Rationing? Fine. Double the costs? Fine. Fiscal cliff? Fine. Double taxes? Fine. Shut down drilling? Fine.
THIS THING HAS TO GO OVER THE CLIFF!!!!
For some reason the idiots who think we can “play in the system” and we only need to “try harder” keep rolling out their lame arguments and expecting traction. Half the GOP won’t even vote. Many of the ones who do only end up voting for collectivism light. If you won’t even vote and when you do vote you mock and reject liberty then what makes you think you ever fix this? Oh yeah, right, I forgot…”it took 100 years to get here, you don’t fix it overnight”. Yeah.
I don’t know what to say other than it is going to take a few million dead people to get the attention of a population. Some boots on necks, martial law, economic collapse, lawlessness, rounds down range, good ole chaos. I don’t know what else. Our money is becoming worthless, the government spies on you and molests you with blue gloves and now tells you what to eat and drink. Collectively you are all pathetic and there isn’t anything “civil” that will cause you to resist. Fine. Let the whirlwind come then.
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Oilfield_Trash
Posted on November 16, 2012 at 8:07amCouldn’t agree more… looks like what it will take. Sad but So
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338lapua
Posted on November 16, 2012 at 8:18amTime for a little “demographic cleansing”.
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Government_Goodies
Posted on November 16, 2012 at 8:23amTHIS THING HAS TO GO OVER THE CLIFF!!!!
Yup. The EBT cards have to quit working before we can get the country back from the children.
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bald stick
Posted on November 16, 2012 at 8:24amSad to say, I agree with most if what you have said. It will be more than a few million people I fear. The few million will be in the U.S. How many millions throughout the rest of the world?
I pray, “Come Lord Jesus”.
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PorkPIG
Posted on November 16, 2012 at 7:51amI have refused to participate in heath insurance since 2006 , It its pure socialism at the core weather its run privately or by the state . Anyway you look it takes from me and give to someone else and prevents the free Market from setting the price . I was told by a super liberal Laywer that there is a clause to allow ppl to opt out and Im seriously looking into it .
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bigbear_awake
Posted on November 16, 2012 at 7:51amdefund it
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Halloween
Posted on November 16, 2012 at 1:02pmIt can not be defunded, it’s too late. The taxes that are levied include the funds to run Obamacare and the Republicans just let it happen without a fight.
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Stab_friendly
Posted on November 16, 2012 at 7:47amThat’s it GOP governors, run right into the Obama trap..
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John 3:16
Posted on November 16, 2012 at 7:45amTime for all the Red states to tell Dumbo Obama to stick it, we won’t do it and what are you going to do about it. Let’s man up to the Bully communist.
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Snowleopard {gallery of cat folks}
Posted on November 16, 2012 at 7:43amNow the federal government will implement their madness across the land irregardless of what or how the states wish: the key sentence in the article is the states seeking to set up their own plans have until Jan 1, to get approval from the federal government that gave us this nightmare in the first place.
Communism is one step closer to killing the Republic; but I for one will never yield and never surrender.
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WarMunger_Al
Posted on November 16, 2012 at 7:21amSure, here it comes…..Give the federal government more control of your state. I bet there is lots of fine print in allowing the federal government to run it for them. I have an idea. Why don’t the states “rebel” and don’t implement this atrocity in their borders? Why don’t the states say, “make me..”
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Rothbardian_in_the_Cleve
Posted on November 16, 2012 at 7:32amYou need to stop. Glenn says stuff like that is just “crazy”. You’re supposed to buy gold, drop your pants bend over, smile, evangelize conservative principles and vote for a RINO.
Why is this so hard for you to understand? Freedom is only something Americans pay lip service to, NOBODY really wants to lift a finger for it.
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dshamis20
Posted on November 16, 2012 at 7:43amAfter working for over 14 hours trying to make ends meet for my family and I, stopped by the local market for basic materials, milk,eggs, some stuff for my 2 kids. Went to checkout, I waited while I watched a mid 50 latina to gather all her supplies to pay. Do you know how much cupcakes and shrimp can be purchased for 125 bucks. That’s all this middle aged women bought, cupcakes and shrimp. EBT card swiped and she glanced at me and smirked. As she walked away I realized the irony behind all of this. Welcome to America!
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RightUnite
Posted on November 16, 2012 at 6:57amGet ready for rationing…..
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RJJinGadsden
Posted on November 16, 2012 at 7:18amIf you have ever been to a VA hospital or clinic you already know that has been happening for decades. It seems to me that 0bamacare is being built around an already national embarrassment of a failure. And, it has never mattered which party was in office with this.
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