Health Care Exchanges And The Two Americas

Photo Credit: Reuters In the Obamacare era, there are two Americas. Half the states have refused to set up the health insurance exchanges, ignoring a Friday deadline for states to take on core requirements of the law. They’ll hand over the keys to the Obama administration, which will play an outsize and risky role in driving critical health insurance decisions that are typically the province of state governments.

Barring any surprise last minute Friday announcements, in those 25 states — nearly all led by Republican governors — the feds must set up health insurance exchanges. Enrollment starts in October, and on Jan. 1 those online marketplaces are supposed to provide affordable health coverage for millions of Americans.

Republicans who voted against the law and still clamor to repeal Obamacare believe the feds are heading for a nationwide failure.

“I have a hard time understanding how the administration expects to have exchanges up and running by Oct. 1, ” Orrin Hatch, the top Republican on the Senate Finance Committee, said Thursday.

For the administration, it’s a dangerous endeavor: the text of President Barack Obama’s health law didn’t envision widespread abdication by the states. There’s not much of a playbook for federal health officials to follow. And if it goes horribly awry, not only will the Obama administration be blamed, the entire health care law could be in trouble.

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