- Associated Press - Thursday, January 3, 2013

WASHINGTON (AP) — Injecting a rare shot of bipartisanship in the nation’s contentious health care overhaul, the Obama administration on Thursday cleared four Republican-led states to build their own consumer-friendly insurance markets.

With open enrollment for millions of uninsured Americans just nine months away — Oct. 1, 2013 — the four GOP-led states became part of a group totaling 17 states plus the District of Columbia that have gotten an initial go-ahead to build and run insurance exchanges. Another two states have gotten clearance to run their markets in partnership with the federal government. Seven were approved Thursday.

Significantly, the list also included California, which has nearly 7.5 million uninsured residents, more than any other state. Democratic-led California was an early supporter of President Obama’s health care law and had been working diligently on its plan.

Insurance exchanges are not something consumers are familiar with.

“Most people don’t really know what those words mean, but that’s OK,” said Rachel Klein, executive director of Enroll America, a nonprofit trying to educate the public about new benefits under the federal health care law. “What they really need to know is that there’s going to be a new way to buy health insurance.”

The new marketplaces are supposed to take the confusion and anxiety out of buying private health insurance for individuals and families who buy their coverage directly. Exchanges are meant to have the feel of an online travel site, an Expedia or Orbitz.

Exchanges also will offer some relief from sticker shock. Under the new law, about 8 in 10 customers in the new marketplaces will be eligible for income-based federal aid to help pay their premiums.

Small businesses will have separate access to their own exchanges.

The approvals announced Thursday are provisional; administration officials said more work remains to be done before they’ll issue final sign-offs.

The GOP-led states conditionally approved are Idaho, Nevada, New Mexico and Utah. Idaho and Utah have Republican governors and legislatures. Nevada and New Mexico have GOP governors, but Democrats control their legislatures.

“We’re on track for Idaho having a say over how this process works, instead of having the federal government dictate all of it,” said Jon Hanian, spokesman for Republican Gov. C.L. “Butch” Otter. The legislature still has to weigh in.

A fifth Republican-led state, Mississippi, may yet win approval. However, the administration’s decision is complicated by a legal dispute between Republican state officials. The governor does not want to participate, while the insurance commissioner does.

The federal government will set up and run the new marketplaces in states that opt out of playing any role, and 19 Republican-led states have taken that route.

The rest of the states are either pursuing partnerships with Washington or still mulling their options. Arkansas got its initial approval for a partnership on Thursday, meaning it will handle consumer issues and oversee health plans while Washington takes on the back-office tasks of enrolling consumers and determining subsidies. Earlier, Delaware received its partnership approval.

Right now, exchanges exist in only a couple of states, although some large private employers also are experimenting with them.

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