States were given until until 14 December, 2012 to decide if they would build a health insurance exchange (HIX) or defer to the federal government. The health insurance exchange system is central to the government’s ability to provide regulated health insurance services to individuals if it’s not provided to them by an employer.
The deadline has come and gone, and the exchange concept was rejected by more than half of the states. They are simply refusing to participate in this crucial component of the Affordable Care Act law. So far, 18 states and the District of Columbia have plans to build and manage their own exchanges, while seven others have asked the federal government to create their exchanges.
The majority of the states carried by Mitt Romney in the 2012 presidential election refuse to build an exchanges. These states, generally speaking, would vote to repeal Obamacare. State leaders carefully listened to their constituents when they decided to say no to spending taxpayer money to build a HIX of their own.
It isn’t just the Romney states. States that President Obama carried in the election are also rejecting the plan. Most notably Florida, Ohio, Pennsylvania, Virginia, New Jersey, Wisconsin and New Hampshire said no. Is this politics or economics?
Earlier this month Texas Governor Rick Perry, who also nixed the idea of his state creating an exchange, said “The idea that you’ve got a state-instituted exchange, but it has to be federally approved. So the fact is the federal government’s going to have to run these,” Perry said. “And they don’t have the expertise, nor do they have the money.” Perry is just one of many governors predicting that the implementation of Obamacare is “going to be a disaster.”
Could this lack of state participation mean that states will not have access to health insurance plans by 1 October, 2013, as mandated by law?
The uncertainty of the exchanges raises serious the questions. Can Obamacare be fully implemented by 2014 when the individual mandate requires all citizens to have private health insurance? Given the enormity of building the complex system, gathering the massive amounts of data required, and gaining cooperation at the state level, it seems probable that failure or a serious delay is looming.