* Ohio, Michigan and Florida willing to work with Washington
* Many states face pressure after Obama's Nov. 6 reelection
By David Morgan
WASHINGTON, Nov 16 Five Republican governors
rejected on Friday a major provision of President Barack Obama's
healthcare reform law that calls on U.S. states to set up online
health insurance markets where consumers can purchase private
coverage at federally subsidized rates.
That makes it likely that the federal government will
establish its own markets, known as healthcare exchanges, in
those states and potentially supplant state control of private
individual insurance markets.
But in what could be a sign of thawing relations between
administration officials and some state Republican leaders,
three of the five governors -- representing Ohio, Michigan and
Florida -- expressed a willingness to work with Washington as
reforms inch toward a Jan. 1, 2014, deadline for full operation.
Wisconsin Governor Scott Walker and Georgia Governor Nathan
Deal said they would not cooperate at all.
Missouri Governor Jeremiah Nixon, a Democrat, said the state
would not run its own exchange but did not take a position on a
federal partnership. He said the state legislature could take up
the issue early next year.
Meanwhile, Indiana Governor Mitch Daniels, a Republican,
deferred to the state's governor-elect, Mike Pence, also
Republican, who has said he intends to oppose both a state-based
exchange and a federal partnership after assuming office next
The announcements came a day after the U.S. Department of
Health and Human Services extended its deadline for states to
say whether they would operate their own exchanges. The
positions reveal an emerging split between Republican governors
who had appeared to form a united front against healthcare
reform before Obama's Nov. 6 reelection ensured the law's
Many governors have dragged their feet on implementing the
Patient Protection and Affordable Care Act, hoping Republican
Mitt Romney would defeat Obama and repeal the law. They are now
deciding whether to set up their own exchanges, accept a
partnership with the federal government or allow Washington to
"What this reflects is the difficult position of some of
these governors," said Jennifer Tolbert of the nonpartisan
Kaiser Family Foundation, which tracks healthcare issues. "While
they may oppose the new reform law and its requirements, some
also don't want the federal government to come in and run the
exchange and take over that responsibility."
Friday was the original deadline for states to tell the
administration whether they plan to operate their own exchanges
and file blueprints to show how they would do it. The
administration extended the deadline to Dec. 14 after governors
requested more time to comply.
The Affordable Care Act is scheduled to extend health
coverage to more than 30 million uninsured Americans beginning
Jan. 1, 2014. About half of those would be covered by exchanges,
designed to allow working families to purchase coverage at
A MEETING IN FLORIDA?
At least 17 states already have told the administration that
they will create their own exchanges, according to sources
familiar with the situation. An HHS spokeswoman could not
confirm that number. Experts predicted the total could rise to
20 by the time the new deadline passes.
As many as 15 states from Georgia and Texas to Wyoming and
Maine opposed the exchanges outright before the election.
But some of those, including Nebraska, have since opted to
work with the federal government on an exchange. Others say they
are still deliberating. Over the past week, Kansas has rejected
all participation in an exchange while Nebraska has agreed to
seek a federal partnership.
States that reject the call for state-run exchanges but opt
for a federal partnership could better ensure smooth market
operations for residents than states that reject exchanges
outright, experts say. They could also have an easier time
adopting a state-based operation in coming years.
All five Republican governors who announced their plans on
Friday complained that the Obama administration has been slow to
release details about how exchanges should operate and
complained that the law has proved too inflexible to meet the
needs of individual states.
"At this point, based on the information we have, states do
not have any flexibility to build and manage exchanges in ways
that respond to unique needs of their citizens or markets," Ohio
Governor John Kasich said in a Nov. 16 letter to the Centers for
Medicare and Medicaid Services, an HHS agency that is
implementing the law's exchange provision.
"Regardless of who runs the exchange, the end product is the
same," he added.
But Kasich and Michigan Governor Rick Snyder both suggested
their positions could change as details emerge.
Florida's Republican governor, Rick Scott, said in a letter
to HHS Secretary Kathleen Sebelius that he could not see how an
exchange would improve healthcare access while lowering costs
for Florida residents.
But Scott said Florida was willing to "partner" with the
administration to find a solution. He invited Sebelius to a
meeting to discuss the issues.
States have until Feb. 15, 2013, to say whether they would
prefer a federal partnership exchange.
Whatever the choice, Sebelius has pledged that Americans in
all 50 states will have access to coverage through exchanges
when the Affordable Care Act comes into full force in 2014.