Many Republican governors and state lawmakers are refusing to move forward with implementing health insurance exchanges until after the Supreme Court rules on the constitutionality of the federal health reform law, the Washington Post reports.
For example, New Jersey Gov. Chris Christie (R) on Thursday vetoed a bill from the Democrat-controlled Legislature to set up the state's exchange. Further, in six states where the GOP controls both the governorship and the state legislature, lawmakers have not even considered measures to establish the exchanges.
About 24 states have made little progress to set up the exchanges, but many analysts and state lawmakers say the approach is "more of a political statement than a strategy with potential to derail implementation" of the overhaul, according to the Post (Aizenman, Washington Post, 5/12).
However, there have been exceptions in at least six states. Last year, Nevada Gov. Brian Sandoval (R) did not veto an exchange measure approved by the Democratic assembly, while Mississippi Gov. Phil Bryant (R) promoted exchange legislation in his state (National Journal, 5/13).
Some States Will Have Little Time To Act
Should the Supreme Court find the overhaul constitutional, states that have not moved forward with implementation on an exchange could have little time to adapt, according to the Post. In states that cannot prove they have made significant progress in setting up an exchange by Jan. 1, 2013, the federal government could establish an exchange for them (Washington Post, 5/12).
States that begin implementing an exchange after the Supreme Court issues a decision -- which is expected in late June -- will have about six months to pass legislation to authorize the exchange, hire a board to oversee it, find vendors to develop the technical infrastructure and have the exchange nearly operational by Jan. 1, 2013, to begin accepting customers by fall 2014 (Kliff, "Wonkblog," Washington Post, 5/11).
Several Republican governors -- including Christie and the governors of Arizona, Nebraska, New Mexico, Tennessee and Virginia -- have indicated they are reticent to hand over authority to the federal government to establish an exchange in their state.
Kevin Roberts, a spokesperson for Christie, said the governor has established enough technical groundwork to move forward if the high court upholds the overhaul. "Since the beginning we've taken steps to maintain control at the state level," Roberts said, noting that the state assembly could adopt an exchange bill in its fall session or Christie could use an executive order to set up the exchange.
Some Democratic governors whose efforts to set up exchanges have been blocked by Republican legislatures also are considering executive orders. For instance, Kentucky Gov. Steve Beshear (D) earlier this month said he would use an executive order if the high court upholds the overhaul. New York Gov. Andrew Cuomo (D) last month issued an executive order establishing an exchange after Senate Republicans rejected legislation to create one (Washington Post, 5/12).
Medicare Officials Recommend Against the Word 'Exchange'
In related news, CMS officials have said the word "exchange" could create confusion for consumers and say the term should not be used in enrollment materials, Kaiser Health News reports.
CMS Office of Communications Director Julie Bataille in a meeting of outreach advisers last week did not indicate a preferred substitute but said, "Words like 'marketplace' resonate much more with the consumer and also tend to be something that is all inclusive."
Bataille said "exchange" has different meanings to consumers, including the idea that they could have to swap something. She said CMS would seek public comment on the enrollment materials before making a final decision on whether to use the term "exchange" (Jaffe, Kaiser Health News, 5/11).