The federal government has extended the deadlines for states to opt in to running or helping to run health insurance exchange starting in 2014. The initial deadline was today, but states now have until December 14 to declare their intention to administer the exchange at the state-level, and until February 15, 2013 to choose to run a partnership exchange (where the federal government and state government are each responsible for different exchange functions).
Our Governor reaffirmed yesterday that Texas will not pursue a state-based exchange for 2014. It is important to remember that Texas will still have an exchange up and running on January 1, 2014. Maybe Texas will pursue a partnership exchange (which seems unlikely given the Governor’s stance and the fact that the deadline occurs before the legislature will be able to weigh in). But even if we forego that opportunity as well, Texas will have an exchange that is administered by the federal government, along with several other states (possibly around half of states will have a federal exchange). The federal exchange will allow consumers to comparison shop and provide sliding-scale subsidies for low- and moderate-income enrollees.
Texas can decide at a later date that it wants to transition from a federal exchange to a partnership or state-based exchange in 2015 or beyond. All of Texas’ work to build and implement an exchange could be funded under federal grants that the state can apply for through the end of 2014.
At this point, 16 states have opted to run their exchange starting in 2014, and another 2 already run a state-based exchange. Nineteen states (including Texas) have declared that they will not run an exchange, and 9 are still undecided. The remaining five states are considering or are pursuing a partnership exchange, and they may be joined by February 15 by other states that have opted out of a state exchange or are still undecided.
The Governor’s continued opposition to running the new health care marketplace at the state level communicates a political message, but not one that is based on how to best expand health coverage in Texas. With the re-election of President Obama there is no longer a question about whether health reform will be implemented. It will. Now Texas should focus on how to implement health reform in a way that covers as many Texans as possible and helps hold down health care costs.