In a letter to U.S. Health Secretary Kathleen Sebelius released late last week, state governors claim that some of the federal healthcare law’s requirements related to exchanges may have a negative effect on the autonomy of those states.
The decision to implement health insurance exchanges requires a number of complex policy decisions amid aggressive timelines," wrote the
"States can only make suitable decisions if provided with complete and timely information regarding the structure of a state-federal partnership, essential health benefits and the design of a federal exchange," it added.
Governors representing both parties signed the letter, including Iowa Governor Terry Branstad, a Republican, and Illinois Governor Pat Quinn, a Democrat. The governors represent the association's health committee.
The exchanges, called the Health Benefits Exchange and required by the nation’s health care overhaul signed into law by President Barack Obama give states the option of creating exchanges alone, joining with neighboring states or opting out entirely, which would result in the federal government establishing exchanges within their borders.
"States would be required to cede many operations that have been traditionally handled at the state level, such as Medicaid eligibility," the governors wrote about all three exchange versions.
States have invested taxpayer resources in state-based eligibility systems since the Medicaid program began and want to avoid duplication of effort," the letter added.
The federal government also would not send funding to states for establishing new exchange functions after 2012, which could lock them "into an all-or-nothing approach."
The governors wrote that this could hamper development of exchanges because currently "many states are undecided on implementation strategies because of various uncertainties, including the lack of final rules and regulations."
The law, signed in 2010, gives states great latitude in establishing exchanges, which has left many scrambling to build computer systems, hire staff and design exchanges from scratch.
In the letter, the governors asked the federal government to take over areas where they do not have current operations, such as facilitating advance payment of premium tax credits to insurers. They also sought help in certifying technology and software, such as a benefits calculator, that states could build upon for their exchange systems.
