Health Insurance

State health exchanges: why Republicans have opted out

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.e8616 (Published 2 January 2013)
Cite this as: BMJ 2013;346:e8616

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  1. Ed Susman, contributing writer
  1. 1West Palm Beach, FL, USA
  1. edwardsusman44{at}aol.com

Ed Susman looks at how plans for state based, health insurance exchanges are progressing following the 14 December deadline for a state decision

On 1 October 2013, millions of Americans aged 18 to 64 will be able to sit down at their computers and within a few minutes obtain health insurance, many of them for the first time. These people, who are not covered by their parents or their workplace, will enter a cyber supermarket that will fulfill the goals of the Affordable Care Act—also known as Obamacare.

Sustained as law by the United States Supreme Court in June 2012, and preserved by the re-election of Barack Obama as president in November, the Affordable Care Act is slowly grinding its way into the health insurance market. Key elements of the act are the health insurance exchanges—the places where healthcare plans are certified by a state agency and then set loose on the market. The plans will be run by individual states, state-federal hybrid agencies, or—if states opt for this—the federal government.

In a political anomaly, most of the states with Republican governors who have carried the banner in favor of “states’ rights” for decades have decided to let the federal government handle their state plans.

Overall, state run exchanges are being established in New York, Vermont, Massachusetts, Rhode Island, Connecticut, Maryland, Kentucky, Mississippi, Minnesota, Colorado, New Mexico, Idaho, Iowa, Oregon, Washington State, the District of Columbia, California, and Hawaii. State-federal partnership exchanges are being established in Delaware, West Virginia, North Carolina, Ohio, Michigan, Illinois, Arkansas, and South Dakota.1

Although it might be possible …

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