Feds will run most of new health insurance exchanges

The District of Columbia and 17 states will run their own exchanges

The federal government will run health insurance exchanges under the Affordable Care Act (ACA) in 26 states, while seven states will partner with the federal government and 17 states and the District of Columbia will run their own marketplaces.

Friday was the deadline for states to declare if they wanted to partner with the federal government on an exchange. Just prior to the deadline, six GOP governors—in Mississippi, New Jersey, North Carolina, Ohio, Tennessee, and Virginia—rejected a partnership, confirming that the federal government will run health insurance exchanges in their states.

Of the 26 states that will have the federal government run an exchange for them, 24 have Republican governors. Meanwhile, four Republican-led states opted for a state-run exchange.

Writing at "Wonkblog," the Washington Post's Sarah Kliff notes that some states opting for federally run exchanges may be moving closer in line with House Democrats' original health reform bill, which included a single national insurance exchange. The provision later was replaced by state-run marketplaces in the Senate version.

Reaction to announcements

Proponents of the ACA have said the federal government might be more successful in implementing the law's provisions. Dena Mottola Jaborska, director of organizing at New Jersey Citizen Action, said, "We're perfectly happy for the federal government to take the lead on this because we know they will do everything in its power to make it successful."

Meanwhile, Dan Mendelson, CEO of consulting firm Avalere Health, added that federal control will give the exchanges "[c]onsistency and control."

Some experts predict that states eventually will play a part in exchanges, even if they opted for a federally run marketplace. The Obama administration also has said that states can change their minds and opt to run their own exchange in the future.

Republicans who oppose the ACA continue to assert that the federal government will not have enough time to set up exchanges for so many states. Senate Finance Committee ranking member Orrin Hatch (R-Utah) on Thursday said, "I have a hard time understanding how the administration expects to have exchanges up and running by Oct. 1" (Cheney/Millman, Politico, 2/15; Somashekhar, Washington Post, 2/15; Radnofsky, Wall Street Journal, 2/15; Kliff, "Wonkblog," Washington Post, 2/18; Alonso-Zaldivar, Modern Healthcare, 2/17 [subscription required]).

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