Obama to Control Most Health Exchanges

32 states have opted out of building an exchange or are expected to opt out.

More than half of the state exchanges to be created under the 2010 U.S. health-care overhaul are expected to be run by the federal government, offering insurers and consumers uniform criteria in at least those areas.

While a final tally won’t come until at least tomorrow, 32 states have either said they’ll let the U.S. build all or most of their exchanges or are expected to, according to Avalere Health, a Washington-based consultant. That puts the onus on the Obama administration to set up and maintain the marketplaces that sit at the heart of the Affordable Care Act’s mandate to expand medical coverage to as many as 30 million people.

State Partnerships

Avalere projects that the number of states in partnership with the government may eventually reach 12. The deadline for states to declare whether they’ll assist the government on exchanges is Feb. 15.

Playing Politics

Politics, not practical concerns, has driven most Republican governors’ decisions to opt out of building an exchange, said Robert Blendon, a health policy professor at the Harvard School of Public Health in Boston. Kansas Governor Sam Brownback decided to let the federal government build his exchange against the recommendation of the state’s insurance commissioner, Sandy Praeger, who is also a Republican.

Government Contracts

“Time is our enemy at this point,” Deal said in a telephone interview.

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