Most Governors Content to Let Feds Run Health Insurance Exchanges in Their State

Thirty-two states have elected to let the federal government run health insurance exchanges as required by the Patient Protection and Affordable Care Act in their state. Of those, seven have requested to do so in partnership with the federal government.

Friday was the deadline for U.S. states to announce their intention as to whether they will create their own health insurance exchanges, work in partnership with the federal government to create one, or create one themselves. Eighteen states and the District of Columbia will run their own health insurance exchanges. Early last week the US Department of Health and Human Services announced conditional approval for exchanges in six of those states: Colorado, Connecticut, Oregon, Washington, Maryland, and Massachusetts.

The New York Times described the final tally as a “setback” for the administration of President Barack Obama. ”Most analysts did not anticipate that the federal government would end up playing such a big role in the operation of exchanges nationwide,” Carolyn Pearson, a director at the Washington, D.C., consulting firm Avalere Health, told Bloomberg.

While all of the states that declined to set up their own health insurance exchanges have Republican governors, five states with Republican governors have agreed to create their own exchanges.

What follows is a list of each state’s intentions, although a handful have not publicly released their decision. Next to each state is a link to a source with more information. Six states with asterisks (*) indicate those that received conditional approval on Monday.

States that intend to run own exchange
California (Bloomberg)
Colorado*
Connecticut*
Hawaii (KFF)
Idaho (NYT)
Kentucky (NYT)
Maryland*
Massachusetts*
Minnesota (KFF)
Mississippi (KFF)
Nevada (KFF)
New Mexico (KFF)
New York (NYT)
Oregon*
Rhode Island (KFF)
Utah (Bloomberg)
Vermont (KFF)
Washington*
District of Columbia (KFF)

States seeking to partner with federal-run exchange

Arkansas (KFF)
Delaware (Bloomberg)
Illinois (Bloomberg)
Iowa (Bloomberg)
Michigan (KFF)
North Carolina (Bloomberg)
West Virginia (KFF)

States deferring to federal-run exchange

Alabama (KFF)
Alaska (KFF)
Arizona (KFF)
Florida (KFF)
Georgia (KFF)
Indiana (KFF)
Kansas (Bloomberg)
Louisiana (KFF)
Maine (KFF)
Missouri (KFF)
Montana (KFF)
Nebraska (Bloomberg)
New Hamshire (KFF)
New Jersey (NYT)
North Dakota (KFF)
Ohio ????? (KFF)
Oklahoma (KFF)
Pennsylvania (NYT)
South Carolina (KFF)
South Dakota (KFF)
Tennessee (NYT)
Texas (KFF)
Virginia (NYT)
Wisconsin (NPR)
Wyoming (KFF)

All the exchanges, both federal and state, must be in operation by Oct. 1, 2013, to allow open enrollment for insurance plans to begin on Jan. 1, 2014. States that intend to establish a partnership exchange must inform CMS by February 15, 2013. States that decide later to establish their own exchanges have until December 31, 2014 to apply for establishment grants.

Previously: 

Decision Day for Health Insurance Exchanges: 3 Questions

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