Like it or not, President Obama won a second term, and his health care law is here to stay. The Affordable Care Act was one of the biggest matters of debate during the election, but now that there's no chance of repealing it, state and federal governments have to get to work implementing it.
Yesterday, however, facing Republican complaints, the Obama administration for the second time pushed back a key deadline states face as they begin to build a new health care infrastructure.
State leaders now have one more month to decide whether to build their own health care exchange system -- an online marketplace where consumers can choose from a variety of competing private insurance plans. If they don't want to build their own, states can instead leave it up to the federal government to run their state-based system, or enter into a partnership with the federal government. The exchanges are supposed to be up and running by 2014 and are a core part of the 2010 law -- according to nonpartisan projections, starting in 2016, between 23 million and 25 million people will receive health care coverage through the exchanges.
Ahead of the election, a number of Republican-led states stalled work on the exchanges, in the hopes that a Romney administration would roll back the new requirement. But with little time left to make a decision, GOP leaders are beginning to begrudgingly choose a path forward. As of Friday afternoon, according to a tally by the Associated Press, just 11 states have yet to say whether they'll set up their own or leave it to the feds -- all but one of those states have Republican governors.
These states have found themselves "behind the proverbial eight ball," as Prof. Jay Himmelstein put it, in part because of politics and in part because of legitimate concerns.
"I think there's still a lot of resistance that's been built up and a little bit of embarrassment about not being prepared to follow the law of the land," said Himmelstein, chief health policy strategist at the Center for Health Policy and Research at the University of Massachusetts Medical School. "That being said, the policy track and the IT track [represent] relatively big changes in the economy, and they do take some time to implement."
A number of Republican-led states have defiantly rejected the seemingly small-government option of building their own exchanges, charging the state-based exchanges "are not state-based at all," as South Carolina Gov. Nikki Haley put it.