States wrestle with health exchange choices

Oklahoma has opted not to proceed with a state-based exchange or with the Medicaid expansion, while Republican governors from Tennessee, Utah and Iowa continue to press the Department of Health and Human Services for more guidance.

Politico: Next Up For Obamacare: Launching The Exchanges In 2014
Now that the elections saved the health care law from the threat of repeal, the Obama administration and its backers are turning their attention toward getting the law right — before the next elections come around in 2014 (Haberkorn, 11/20).

Politico: HHS Looks To Step Up Role In Health Exchanges
The last thing the Obama administration wanted to do was come into a bunch of states and start running health insurance exchanges. But when the new insurance marketplaces open for business late next year, it's clear that the Department of Health and Human Services will have a much bigger job than it wanted (Millman, 11/20).

The Associated Press: State-Run Health Care Exchange Nixed
Oklahoma will not establish a state-run health insurance exchange under the federal health care law or expand its Medicaid eligibility to provide coverage to thousands of low-income, uninsured citizens, Gov. Mary Fallin announced Monday. The Republican governor's move puts Oklahoma's insurance exchange, required under the health care reform law, in the hands of the federal government (Murphy, 11/19).

Tulsa World (Oklahoma): Fallin Rejects Health-Care Exchange
The decision means Oklahoma will not do anything to accommodate the federal health-care law known as "Obamacare." It also means the state will skip an opportunity to help some 693,000 uninsured Oklahomans, 18.7 percent of the state population, get coverage through the federal government (Greene, 11/20).

Politico Pro: Utah Asks HHS About ACA Exchanges
Almost three years after President Barack Obama's health care law passed, Utah still doesn't know how its small-business exchange fits into the picture. On Monday, Utah Gov. Gary Herbert sent HHS Secretary Kathleen Sebelius a list of 10 "critical questions" about federal exchanges — and he says he needs answers before making any decision about the future of Utah's exchange. Herbert asked Sebelius a variety of questions about a federal exchange's regulatory powers, costs and consumer relations. He asked what a federal exchange would cost the state, taxpayers and the private sector, and how the federal exchange would handle existing state laws. Herbert also wanted know how Utah's existing systems would "link" to the federal exchange (Millman, 11/19).

The Associated Press: Haslam Blames Feds For Delay In Health Care Choice
Republican Gov. Bill Haslam (of Tennessee) said Monday that a lack of information from the White House is delaying a decision about whether the state should run its own health insurance exchange under the new federal health care law. Haslam told reporters that President Barack Obama's administration has refused to address a series of questions about the health insurance marketplaces raised by Republican governors, including whether states would be able to create wellness-based incentives to encourage healthy behavior (Schelzig, 11/19).

Kaiser Health News: Capsules: States Detail Questions About Their Exchange Options
Iowa Gov. Terry Branstad said Friday that he will build a health exchange in his state – as soon as the Obama administration can explain exactly what that means. The Republican governor submitted 50 questions to Health and Human Services Secretary Kathleen Sebelius about how the state-built online insurance markets are supposed to be set up. … Branstad and New Jersey Gov. Chris Christie, also a Republican, are more public than some other state leaders in their criticism of the health law, but they are not the only ones demanding answers on how the exchanges must be set up. A National Association of Insurance Commissioners committee is compiling a working document of state queries about exchange regulations, which had 40 questions as of Monday afternoon (Rao, 11/19).

The Hill: Bipartisan Bill Would Widen Exemption From Health Insurance Mandate
New legislation would allow people an exemption from the healthcare mandate by filing an affidavit with the IRS. Those seeking the exemption would be required to tell the IRS that they don't have insurance because of their religious beliefs. If those seeking the exemption later used healthcare services under the law, they would lose their eligibility for the exemption from buying insurance and would have to pay a penalty. The bill, H.R. 6597, has drawn the support of more than two dozen Democrats, including Reps. Carolyn Maloney (N.Y.) and Barney Frank (Mass.). It is also supported by more conservative Republicans, including libertarian Rep. Ron Paul (R-Texas) (Kasperowicz, 11/19).