* States get extra time to file for health exchanges
* Many who waited for the election now need more time
* Several states oppose exchanges but some opposition may
By David Morgan and Alina Selyukh
WASHINGTON, Nov 9 The Obama administration gave
states extra time to work toward setting up new health insurance
exchanges on Friday, days after President Barack Obama's
re-election ensured the survival of his healthcare reform law.
The move is seen as a concession to dozens of states that
delayed compliance with the Patient Protection and Affordable
Care Act until after the Nov. 6 election. Opponents of the plan
had hoped a victory for Republican Mitt Romney would ultimately
result in the law's repeal.
But with Obama now heading into a second term, and a Nov. 16
federal deadline to declare their plans looming, many states
needed more time to prepare for exchanges, complex marketplaces
meant to offer working families private insurance at federally
subsidized rates beginning in 2014.
Since Tuesday's election, seven states including Texas,
Kansas, Virginia and Florida have said they will not pursue
state-operated exchanges and conservative political donors are
mounting a publicity campaign to encourage more defections.
But there are also signs that opposition could be waning in
In cases where states decide not to participate, the federal
government says it will go in and build an exchange on its own.
"The administration would like to do whatever it can to
bring states in," said Larry Levitt, a healthcare policy expert
with the nonpartisan Kaiser Family Foundation, which tracks
"It's always been expected that if the president got
reelected, a lot of states sitting on the sidelines would
realize they don't want the federal government building a state
health insurance system. That's what we're seeing happening."
U.S. Health and Human Services Secretary Kathleen Sebelius
said in a Nov. 9 letter to governors that the administration
still expects states to declare whether they intend to operate
their own exchanges by next Friday.
But they now have until Dec. 14 to file blueprints showing
how they would operate the marketplaces. So far, about 13 states
are well on their way to setting up their own exchanges.
States can also choose to develop their exchange in
partnership with the federal government. As many as 30 could go
Sebelius said states that prefer a partnership now have
until Feb. 15, 2013, to declare their intentions and prepare the
appropriate paperwork. She said states can still apply to run
exchanges in subsequent years but emphasized that the start date
for coverage has not changed.
"Consumers in all 50 states and the District of Columbia
will have access to insurance through these new marketplaces on
Jan. 1, 2014, as scheduled, with no delays," she said in the
letter, which described the deadline extension as a response to
state requests for more time.
Analysts characterized the extension as a substantial offer
from the federal government.
"It's about as far as they reasonably could extend, knowing
that the systems have to be ready by Oct 1, 2013," said Patrick
Howard, who advises states on healthcare issues for Deloitte.
The Affordable Care Act, the most sweeping health
legislation since the 1960s, would extend health coverage to
more than 30 million uninsured Americans. About half would
receive coverage through a planned expansion of the Medicaid
program for the poor, and the other half through the exchanges.
The list of states that say they will not participate in the
healthcare exchanges grew this week when Virginia and Kansas
added their names.
Texas, South Dakota, South Carolina, Alaska and Florida
confirmed to Reuters on Friday that they will not participate in
exchanges. Louisiana had also opposed the plan before the
election, but officials there did not respond to inquiries about
their plans under Obama's second term.
But Maine, which advised the administration last April that
it did not intend to pursue a state-based exchange, said on
Friday that further guidance from Sebelius' department could
make a difference.
"It's too soon to tell," said Adrienne Bennett, spokeswoman
for Republican Governor Paul LePage.
"We're willing to look at the information and move forward.
But we can't move forward if we don't have information from the
Obama administration. So we're in a holding pattern," she said.
Several Republican advocacy groups are expected to push
against the implementation of Obama's healthcare law. Americans
for Prosperity, a conservative non-profit in part funded by
billionaire Koch brothers, on Friday urged U.S. governors to
reject the state-based exchange options, calling them "flawed"
and "bloated bureaucracies" that put states' budgets at risk.