* Obama administration will intervene in states where
* Health official says latecomers face the biggest
* Exchanges scheduled to be up and running on Jan. 1, 2014
WASHINGTON, March 14 The U.S. government could
have to run more state health insurance exchanges than expected
under President Barack Obama's healthcare law, if U.S. states
pursuing their own marketplaces cannot complete them on time, a
senior official said on Thursday.
The Obama administration has given 17 of the 50 states
conditional approval to set up online exchanges where working
families would purchase private plans at subsidized rates. The
remaining 33 states will all have federally run markets, at
least in the early years of the coming reform era.
But Gary Cohen, who spearheads exchange implementation for
the U.S. Department of Health and Human Services, said some of
the approved states face hurdles that could require Washington
to step in with federal exchanges before open enrollment starts
on Oct. 1.
"I'm absolutely confident that every state will have an
exchange that will be functioning and ready," said Cohen, who
declined to elaborate on the number or identity of states that
could be in for difficulties.
"The type of exchange may be different," he told reporters.
"(But) there will be an exchange of one kind or another in every
Obama's Patient Protection and Affordable Care Act requires
Washington to provide an exchange in any state that cannot or
will not set up their own.
The exchange initiative is expected to insure 26 million
Americans, many of whom currently have no coverage, according to
the nonpartisan Congressional Budget Office. A planned expansion
of the Medicaid program for the poor is likely to cover another
12 million people.
Both the exchanges and the Medicaid expansion are due to
begin providing coverage on Jan. 1, 2014.
Republicans and other healthcare reform critics have warned
of potential problems for states, saying the administration has
been slow to release rules governing implementation.
Many states also held off on implementation in 2012 until
after the law survived a U.S. Supreme Court ruling in June and
last November's Republican presidential election challenge to
Cohen said the main hurdles for states are development of
information technology systems for applicant enrollment
eligibility and continued legal and political challenges from
"The biggest challenges are for states that started later.
Obviously, they have less time," he said.
New Mexico and Idaho, two of the few Republican-led states
to move toward establishing their own marketplace, are still
awaiting final approval from their respective legislatures.
But even in Connecticut, one of the first states to embrace
the healthcare exchange model, media reports have described
implementation problems linked to vague or changing federal