Christie has made clear he’s no fan of the health law, and he vetoed Democratic legislation. Obamacare deadline looms for states

For those states that just can’t quite make up their mind, time’s up.

Friday is the day when states are due to declare whether they’ll partner with the White House to build Affordable Care Act health insurance exchanges. After that, the sprint to the finish begins.


To be clear, this isn’t just another bureaucratic deadline: What states choose to do with the Obamacare exchanges has long-term implications for the success of the landmark health care law, not to mention political consequences for the governors and state legislatures that choose to either carry out the law or turn over the keys to the federal government in building exchanges.

And states still trying to figure out what role, if any, they want in these new online insurance marketplaces include some where the governors have been pretty vocal about how much they oppose Obamacare: Utah’s Gary Herbert, Virginia’s Bob McDonnell, New Jersey’s Chris Christie, even Florida’s Rick Scott among them.

Although Friday is technically the final chance for states to make their exchange intentions known, the Department of Health and Human Services has shown flexibility on the verge of previous Obamacare deadlines, offering second, third and fourth chances for states to change their minds. And there are still several key rules HHS has to issue that states will need to fully launch their exchanges.

The next major dates on the law’s implementation calendar are Oct. 1, when enrollment is supposed to begin and Jan. 1, when coverage kicks in. Millions of people, many of whom are now uninsured or struggling to pay for coverage on their own, could qualify for federal subsidies to purchase private insurance in the new online marketplaces.

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It’s sure to be an uneven rollout, assuming implementation doesn’t get pushed back. But it’s coming, whether America is ready or not.

Already, things haven’t gone according to plan. Half the states have turned down constructing their own exchanges in favor of letting the Obama administration step in to do it for them. A handful of state governments will partner with HHS to handle limited pieces of the exchanges, but the bulk of operations will still be run from Washington.

Fewer than 20 — mostly Democrat-led states — are preparing to run exchanges on their own.

Several states have kept their intentions a mystery with a little less than two days to go on the partnership deadline.

In New Jersey, Christie has made clear he’s no fan of the health law, and he vetoed Democratic legislation that would have created an exchange. But he’s running a Democratic state and as a rising GOP superstar, he’s picking his spots carefully. He hasn’t ruled out a partnership — and some health policy experts who have been parsing his words think he may turn it down this week but consent to some shared responsibility down the road.

Florida’s Scott, meanwhile, has continued to vex conservatives with his hot-and-cold approach to the ACA. Scott was once among the law’s most fervent critics, and Florida spearheaded the legal fight that went to the Supreme Court. But Scott has taken a more evenhanded tone in recent months, and Florida lawmakers sound willing to consider a partnership exchange.

Other states, wary of the politics of cooperating on Obamacare, have claimed to want no part in building a health insurance exchange only to quietly agree to partnership functions.

McDonnell has rejected a state-run exchange in Virginia and sworn off a partnership with the federal government. But this week, he said he’d sign legislation that would retain state authority over the management of plans offered on the exchange. That’s precisely the definition of a partnership — even if aides to McDonnell insisted that the exchange was no partnership.

“The governor remains in a posture whereby he supports Virginia’s participation in a federally facilitated exchange while maintaining the control over the health insurance marketplace,” said spokesman Jeff Caldwell. “The governor intends to sign the legislation into law, so long as they only give appropriate authority for Virginia to perform the plan management function within a federally facilitated exchange. … It is likely that a decision will be made by the end of next week.”

Similarly, South Dakota Gov. Dennis Daugaard said last fall that he intended to default to the federal government. But after the election, the state’s insurance commissioner acknowledged that he’d be filing partnership documents.

“They may call it a partnership exchange. I worry less about what the feds call something,” a Daugaard spokesman said at the time. “They’re setting up the exchange. They’re creating it. They’re funding it. They’re creating the software that makes it work — not us.”

Herbert is pitching Utah’s own unique arrangement with HHS. He wants his state to continue running its existing exchange for small businesses while letting the feds handle the subsidized marketplace for individual coverage. But he’s careful not to call it a partnership.

“Some people don’t like the idea of partnership because the concern they have is one partner is superior to the other,” Herbert said in an interview with POLITICO last week.

Wisconsin Gov. Scott Walker, who previously turned down a state exchange, announced Wednesday he hopes to cut his state’s uninsured population by pushing more residents onto a federally run exchange.

Joel Ario of Manatt Health Solutions, the Obama administration’s first exchange chief, said Friday’s deadline could turn out to be a dud, as far as more states signing on as partners right now.

“I wouldn’t have high expectations for states signing up, but that doesn’t necessarily mean their opposition to the federal government,” he said. “At the end of the day, I think the states want the markets to work. There has to be cooperation between the state and federal government, and that could be accomplished in a federal exchange.”

The Obama administration was eager to show off its partnership with President Barack Obama’s home state Wednesday, dispatching HHS Secretary Kathleen Sebelius to Illinois to announce the state’s application had been approved.

“Working together, we will be ready in eight months, when residents of Illinois will be able to use the new marketplace to easily purchase quality, affordable health insurance plans,” Sebelius said in a statement.