* Administration seen handling exchanges for at least 30
* Daunting task raises doubts but officials confident
* Insurance enrollment due to start in October
By David Morgan
WASHINGTON, Dec 13 Fourteen U.S. states and the
District of Columbia so far have told the federal government
they plan to operate healthcare exchanges under President Barack
Obama's reform law, leaving Washington with the daunting task of
creating online marketplaces for at least two-thirds of the
On the eve of a federal deadline for states to say whether
they will run their own exchanges, a top U.S. healthcare policy
official told lawmakers that the exchanges will start enrolling
eligible families starting on Oct. 1, 2013.
"I am confident that states and the federal government will
be ready in ten months, when consumers in all states can begin
to apply," Gary Cohen, director of the Center for Consumer
Information and Insurance Oversight, told a health oversight
panel in the U.S. House of Representatives.
Cohen, whose agency is part of the U.S. Department of Health
and Human Services (HHS), was among federal officials who
testified alongside state health authorities at a hearing of the
House Energy and Commerce Subcommittee on Health.
In written testimony, Cohen said 15 states have told the
administration they will operate their own exchanges. He later
explained under questioning that the count comprises 14 states
and the District of Columbia.
Separately, HHS officials confirmed the count of 14 states
but could not immediately explain why Cohen's written testimony
contained a higher number.
Some experts say the number of states planning to operate
their own exchanges could reach 18 by the time the deadline
arrives Friday. Still, the nonpartisan Kaiser Family Foundation,
which tracks healthcare issues, says only two states - Utah and
Florida - remain undecided.
That would leave at least 30 states in which the
administration would be required to run exchanges, a challenge
that is raising questions about how successfully U.S. officials
can implement a key provision of the healthcare reform law,
known to opponents and advocates alike as "Obamacare".
"I don't envy them for the job that they have," said Dennis
Smith, a former federal healthcare official who now heads health
services in Wisconsin, a state that has decided not to pursue
its own exchange.
"At the end of the day, you're trying to connect a buyer to
a seller. And the fundamental things required to do that are not
yet in place," he said.
The Patient Protection and Affordable Care Act, which Obama
signed into law more than 2-1/2 years ago, is expected to extend
health coverage to more than 30 million uninsured Americans.
Those who enroll starting in October would be covered by
insurance from Jan. 1, 2014.
About half of those newly insured individuals would purchase
private coverage from online exchanges at federally subsidized
rates. Ultimately, the number of people finding coverage through
exchanges is expected to reach 26 million, according to the
nonpartisan Congressional Budget Office.
The remainder would be covered by expanding the Medicaid
program for the poor to cover all adults earning up to 133
percent of the federal poverty level, or about $15,000 for
individuals and $30,600 for a family of four.
Thursday's hearing provided a political stage for partisan
rhetoric about Obama's health reforms, which have survived
repeated Republican repeal efforts, a nail-biting consideration
by the Supreme Court and the Presidential election campaign.
Republicans and state officials from Republican-led states
complained about compliance costs and accused HHS of delaying
the release of vital details and rules needed to move forward on
the exchanges and on the planned Medicaid expansion.
"The uncertain regulatory environment and the overall lack
of response from HHS are not encouraging the states or the
health plans to move forward," said Representative Michael
Burgess, a Texas Republican.
In response, Congressional Democrats and their state allies
stressed the law's benefits for senior citizens, protections for
young adults and the sick, and the prospective economic benefits
from an expected influx of billions of dollars in federal money.
"The (Republican) move now is to delay implementation under
the guise of lack of information," said Representative Frank
Pallone, a New Jersey Democrat.
"The world in fact is not coming to an end," he added. "The
nation will be better because of the Affordable Care Act."
States that don't run their own exchanges would opt for one
of two alternatives: a federally facilitated exchange that
requires minimal state participation, or a federal partnership
exchange in which states help by performing certain duties.
Kaiser Family Foundation expects six states to choose the
partnership option and two dozen to opt for federally
facilitated exchanges. Cohen said the count so far is four
partnerships and seven facilitated exchanges.
States have until Feb. 15 to say whether they intend to seek
a federal partnership exchange. Four have done so already, Cohen
The administration will have to engineer an information
technology system capable of processing operations in a way that
meet the needs of healthcare consumers in different states.
Experts say the biggest challenge will likely be providing
adequate customer service to handle enrollment, as well as
fielding a technology system capable of interfacing seamlessly
with the system of each state government.
Cohen told the panel the administration is building a
website with interactive capabilities and a call center and has
begun testing a data services hub to determine eligibility.