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BREAKING: Health exchanges: Holdout states get last-minute reprieve

November 16, 2012
by Pamela Tabar, Associate Editor
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Last night, Health and Human Services Secretary Kathleen Sebelius extended the declaration deadline for state decisions on health exchanges from today to December 14, the same day the blueprint documentation plans are due from states intending to create their own exchanges.

As of this morning, eight states—Arizona, Idaho, New Jersey, Oklahoma, Pennsylvania, Tennessee, West Virginia and Wisconsin—still had not declared their intentions. The postponement is the second in the past week, and is in response to pressure from the Republican Governors Association, which on Wednesday had requested more time to announce their intentions.

However, most states have already announced their choices, some as early as the summer. So far, at least 17 states and the District of Columbia have submitted agreements to create a state-run health insurance exchange program. Another five states have chosen the state-federal partnership model for their exchanges.

Twenty states have declined to create a state exchange of their own, many of them making their final decisions after the election. Some declaring their refusal as early as July, after the U.S. Supreme Court voted to grant states the right to refuse to create the state exchange program. Those who decline to create a state exchange will have a federally-run exchange by default, but will be able to switch to a state-federal partnership in the future, if desired.

Not everyone waited until the eleventh-hour to declare their intentions. By summer’s end, at least a dozen states had already filed their intent to build state exchanges. Several states have already moved on to the operational blueprint phase; California’s operational plan was approved by its overseeing board members earlier this week.

Other states, such as Maryland, began building their state exchanges several years ago, putting them far ahead of the pack and enabling them to serve as examples for other states.

  • States that choose to create a state-certified exchange must submit an operational plan by Dec. 14, 2012.
  • States that have decided to establish a state-federal partnership exchange must submit an operational plan by Feb. 15, 2013.
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