Faced with a rapidly approaching deadline for establishing state-based health exchanges under the Affordable Care Act (ACA), more than half of all states — including several with conservative control of their legislatures and governor’s offices — have already taken steps to implement this critical piece of the health law set to come online in 2014, according to a report released this month  by the White House. By January 1, 2014, consumers will be able to use exchange as one-stop marketplace to find health care plans that fit their needs and will be able to enroll starting in October 2013. With those dates drawing nearer and nearer, many state legislative sessions are opening with implementation of the exchanges at the top of their priority list.
Even conservative led states such as Alabama have recognized the crucial need to prepare to implement the state-based Affordable Health Exchanges. In September, Governor Robert Bentley told a commission  charged with implementing the ACA that, “even if that bill [the ACA] had never been passed, this was something that we needed to look at,” adding that his goal was to “set up an Alabama health insurance exchange so people in the state, regardless of where you are in life – you will be able to purchase insurance.”
Under the Affordable Care Act, states have already applied for three rounds of federal grants to help them plan and implement exchanges under separate “planning”, “establishment” and “Early Innovator” grant programs. A full 49 of the 50 states have received funding through planning grants while 28 have received establishment grants, with additional states expected to receive funding in February 2012. The Commonwealth fund released a report  on the state of health insurance exchange legislation as 2012 sessions began in January.
“States are taking strong steps to implement health reform,” said  White House Deputy Chief of Staff Nancy-Ann DeParle in a press statement. “The Obama Administration is working in partnership with State leaders across the country. We will ensure Americans in every State have access to an Exchange and the same kinds of insurance choices as Members of Congress.”
Even some conservative governors opposing the ACA in court see the importance of being able to customize the health insurance exchanges to best serve their residents. Despite claiming that the law is unconstitutional, Nevada Governor Brian Sandoval said in his State of the State address  that he realized Nevada needs to “plan for a Health Insurance Exchange so that we — and not the federal government — control the program.” Others remain wary about the Supreme Court’s upcoming decision regarding the Affordable Care Act. South Dakota Governor Dennis Daugaard expressed such concerns in a statement  earlier this month, claiming a need to know “at a minimum…whether this law is constitutional before we pass legislation at the state level.”
At the same time, other state executive branches are moving forward despite legislative inaction. In Minnesota, Governor Mark Dayton is taking the lead on setting up his state’s exchange through the Commerce Department, creating a task force last year and requesting authority to take further steps, despite political divisions that have led some conservative lawmakers to decline to participate in the process at all. In December, the Commerce Department released five prototypes  of what an online health insurance marketplace might actually look like, giving consumers a feel for how the exchange interface might function.
With the clock ticking, states must see movement on their exchanges by the end of this year — either through legislative or executive action — in order to succeed in their purpose of expanding choice, competition, and coverage when they come on line in 2014.
(Devin Boerm contributed to this article.)
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White House — States Moving Forward to Implement Health Reform’s Affordable Insurance Exchanges 
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