HHS Pushes Federal-State Partnerships For Insurance Exchanges

09.19.2011 - National Healthcare Reform

By Marilyn Werber Serafini  -  KHN Staff Writer

Worried that the federal government could end up running new insurance marketplaces for dozens of states, the Obama administration is making a new pitch for cooperation to 46 states and the District of Columbia today.

Health officials from the states are meeting in the District of Columbia with the administration, which is proposing several models for ways to divvy up exchange duties between Washington and the states.

The exchanges, which open in 2014, are a key component of the health law, allowing individuals and small businesses to shop for coverage from a range of insurers, see if they qualify for low-income subsidies to help them buy policies – or enroll in Medicaid if they meet income requirements. The federal government will run exchanges for states that can’t – or won’t – do it themselves.

Exchange legislation efforts have failed in 16 states – a demonstration of the widespread opposition to the law in states governed by Republicans. But the bipartisan participation in today's meeting indicates a level of political pragmatism, even from states who vehemently oppose the law.

Alan Weil, executive director of the National Academy for State Health Policy, described the conundrum Republican governors are facing.

"As political leaders they can say they hate the law, but as head of the executive branch, they have to be prepared," Weil said. "Some are saying they are so confident [the law is] going away that they are not going to do anything. Some are saying they hope it goes away but for now it’s the law. … They are contingency planning."

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