Almost half the nation's states are refusing to set up health care exchanges — a major component of the federal Affordable Care Act — and instead will let the Obama administration run statewide health-insurance-buying programs.
With a key Friday deadline looming, 24 states and the District of Columbia, meanwhile, say they will run exchanges either by themselves or in partnership with the federal government. Two states remain undecided.
A Pennsylvania health official told a congressional panel Thursday the exchange program's "myriad of mandates and onerous procedural requirements" would be an enormous burden for his state.
"As mandates often are, they impose a one-size-fits-all approach and actually make our processes less efficient, not more efficient," Pennsylvania Secretary of Public Welfare Gary D. Alexander told the House Energy and Commerce Committee's Health Subcommittee.
Pennsylvania Gov. Tom Corbett a day earlier said his state won't set up its own exchange, saying "health care reform is too important to be achieved through haphazard planning."
Open enrollment for the exchanges is set to begin in October, with coverage to start in January 2014 — a schedule many states say is unrealistic because they're waiting on more information from the federal government on rules, procedures and costs.
"The number of remaining concerns and unanswered questions simply do not give us the confidence needed to accept responsibility for this project," Louisiana Health and Hospitals Department Secretary Bruce D. Greenstein told the House panel.
Louisiana also has decided to let the federal government run its exchange program — a marketplace where individuals and small businesses can shop for the most affordable coverage and where many will get help from the government to pay their premiums.
But while 24 mostly Republican-controlled states say they will let the federal government run their state's exchange, GOP governors in Nevada and Idaho this week said they prefer a state-run program.
Idaho Gov. C.L. "Butch" Otter, a longtime critic of President Obama's health care plan, said Tuesday that a state-built health exchange is the best option for Idaho, though he left the final decision up to the state legislature, which convenes in January.
"There will be a health insurance exchange in Idaho," the Republican governor said in a statement. "Our options have come down to this: Do nothing and be at the federal government's mercy in how that exchange is designed and run, or take a seat at the table and play the cards we've been dealt. I cannot willingly surrender a role for Idaho."
Nevada Gov. Brian Sandoval also vowed to create a state-run health insurance exchange.
"I have to look at Nevada," he told The Associated Press this week. "I'm not going to compare myself to any other governor. I have to look at the consequences of this very complicated law."
States have until Friday to notify federal authorities if they want to create and run their own insurance exchanges. They also can choose to set up an exchange under a state-federal partnership, with a decision on that option due Feb. 15. If any state is undecided after that, the federal government will run that state's exchange.
The deadline for both decisions initially was last month, but the federal government offered an extension after some governors asked for more time.
Utah and Florida are the lone undecideds. Because Utah already operates its own version of an exchange, Republican Gov. Gary Herbert this week asked Mr. Obama to approve the program, which he said gives 7,600 people and 318 small businesses a choice of 140 health insurance plans.
But Utah's plan isn't designed to offer health insurance to individuals, as required in the federal law, so it's uncertain if the governor's plea will be successful.
In Florida, GOP Gov. Rick Scott, one of the most strident critics of the president's health care overhaul, has softened his tone since the November elections, saying he now is willing to negotiate with the federal government.
But the Republican-controlled Florida Senate this week launched a Web page saying the state can't make a decision on an exchange until the 2013 legislative session and therefore likely wouldn't have time to create a state-run exchange by the mandated January 2014 start even if it wanted to.
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Sean Lengell covers Congress and national politics and can be reached at email@example.com.
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