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GOP states run risk with delay in establishing health care markets

Governors’ inaction opens door for feds

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Republican governors who have balked at creating new private insurance markets under President Obama's health care overhaul may end up getting stuck with the very thing they're trying to avoid.

Unless Mitt Romney wins in November, states that haven't set up the required markets could find Washington calling the shots on some insurance issues the states traditionally manage, from handling consumer complaints to regulating plans that will serve many people.

It could turn into a political debacle for those who dug in to fight what they decry as "Obamacare."

"You're kind of rolling the dice if you think [Obama's health care law] will go away," said Kansas Insurance Commissioner Sandy Praeger, a Republican. If Romney can't make good on his vow to repeal the overhaul, "you are just giving up a lot of authority."

The law envisioned that states would run the new markets, called exchanges, with federal control as a fallback only. But the fallback now looks as if it will become the standard option in about half the states — at least initially.

It would happen through something called the federal exchange, humming along largely under the radar on a tight development schedule overseen by the Department of Health and Human Services in Washington.

Exchanges are new online markets in which individual consumers and small businesses will shop for health insurance among competing private plans. The Supreme Court's health care decision left both state exchanges and the federal option in place.

The exchanges are supposed to demystify the process of buying health insurance, allowing consumers to make apples-to-apples comparisons. Consumers also will be able to find out if they're eligible for new federal subsidies to help pay premiums, or if they qualify for expanded Medicaid.

It's all supposed to work in real time, or close to it, like online travel services. Open enrollment would start Oct. 1, 2013, with coverage kicking in the following Jan. 1.

Eventually, more than 25 million people are expected to get coverage through exchanges, including many who previously were uninsured. As exchanges get more customers, competition among insurance plans could help keep costs in check.

But only the District and 14 states have adopted plans for their own exchanges: California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington and West Virginia. Some could still backtrack.

Kentucky and Minnesota are pushing forward with their own exchanges, and others may be able to partner with the federal government. States face a Jan. 1 deadline for Washington to sign off on their plans.

Meanwhile, the federal exchange is advancing.

HHS contractors are working feverishly to design and test computer systems that would make the federal exchange come alive. It's a top priority for the administration, which is guarding the details closely. Estimated price tag: at least $860 million.

Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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