Florida washed its hands of Obamacare long ago, opting to let the federal government run a health care exchange for the state.
But state Insurance Commissioner Kevin M. McCarty is now scrambling to work with Florida's largest insurer to rescind cancellation notices and let residents keep their health care, even though it violates Obamacare's strict standards.
President Obama's announcement last week that he would let states decide whether to let companies continue to offer plans that flout his own health care law has put state officials back on the hot seat.
"It's unfortunate that the insurance commissioners have been put in this position through no fault of their own," Mr. McCarty said in an interview.
The White House continues to grapple with the poor rollout of the president's signature program. On Monday, a spokesman said the administration is unlikely to meet its self-imposed Nov. 30 deadline to have the HealthCare.gov website fully functional and that a 80 percent success rate is now the best hope.
Among the other 20 percent, White House spokesman Jay Carney said, are those who aren't comfortable enrolling online or who have personal circumstances that are too "complex" to use the website.
Other provisions of Obamacare that are rankling Americans include minimum-coverage requirements and whether large employers should pay for contraceptives.
But the biggest headache stems from the millions of consumers in the individual markets whose policies have been canceled in recent months. Insurance companies say these plans don't meet Obamacare's long list of requirements.
Mr. Obama, who during the health care debate said Americans could keep their plans if they liked them, was forced to backtrack and announce the use of executive authority to let states decide whether policies should be canceled.
The move may have cost the job of the D.C. insurance commissioner, who said a one-year reprieve for bare-bones plans on the individual market could undercut the health care overhaul.
Other commissioners are still on the payroll, trying to keep up with shifting rules while the Obama administration scrambles to smooth out the rocky implementation of the president's signature law.
Sara Rosenbaum, a professor of law and health care policy at George Washington University, said Mr. Obama's move to give states the final decision is "consistent with the Affordable Care Act itself," whose authors wanted to let states set up their own markets and guidelines.
But the line between state and federal responsibilities for Mr. Obama's overhaul has blurred over the past three years, partly because of reluctant Republican governors and a Supreme Court that said states could opt not to expand Medicaid under the law.
In Florida, Mr. McCarty said, some insurance companies voluntarily extended coverage for affected policyholders through 2014 — an early-bird strategy to head off Obamacare standards that take effect Jan. 1.
The state's largest insurer, Florida Blue, did not make such accommodations, so Mr. McCarty promised to work with the company to renew policies.
"It's very frustrating to be in a situation where, quite frankly, the problems were exacerbated by the fumbles of the [Obama] administration in getting out the program of HealthCare.gov," he said.
In Washington — one of the 15 states that embraced the health care reform and set up their own exchanges — Insurance Commissioner Mike Kreidler said insurers would not be able to renew plans that flout Obamacare. He said such a move might destabilize the state-run health care exchange, which is working relatively well, by allowing young, healthy people to stay on low-level plans instead of enrolling in the Obamacare market.
Kentucky's insurance commissioner, Sharon P. Clark, said Monday that she doesn't fear tumult in her state's individual market over Mr. Obama's plan, even though her state also boasts a high-performing exchange.
Like Florida, her state allowed insurers to extend plans into 2014 instead of risking cancellation under Obamacare. She said other states might be having difficulties "because they might not have had the allowance for early renewal."
California Insurance Commissioner Dave Jones is encouraging insurers to let residents keep their health plans in the coming year. He said roughly 1 million residents with canceled plans should have the freedom to renew their plans in line with Mr. Obama's original promise or shop for alternative plans on Covered California, the state's exchange.
While he awaits feedback from insurers, he has found some cancellation notices that include errors, effectively allowing some customers to keep their existing coverage until the end of March.
He does not think the proposed renewals will cause tumult in the state exchange's stability, since there are safeguards within the law to deal with adverse changes to the risk pool. Additionally, estimates show that up to 400,000 Californians could be eligible for subsidies to defray their premiums, making the exchange more attractive.
"These concerns about impacts on the exchange are extraordinarily misplaced People are very price-sensitive. We're encouraging people to shop," he said.
Officials in Tennessee and other states are trying to understand the long-range impact of Mr. Obama's proposal and haven't decided one way or the other.
"The governor and commissioner's primary goal is to maximize Tennesseans' options in the evolving health insurance marketplace," said Alexia Poe, spokeswoman for Gov. Bill Haslam, a Republican. "They also believe that Tennesseans should be able to keep the coverage they were assured they'd be able to keep."
• Dave Boyer contributed to this report.
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