Health Care

Some States Dragging Their Feet On Health Exchanges

  • Playlist
  • Download
  • Embed
    <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

November marks the deadline for states to decide how they'll participate in health insurance exchanges. Those exchanges come from the federal health care law passed in 2010. To find out how much progress the states have made toward their decisions, Audie Cornish talks with Alan Weil, executive director of the National Academy for State Health Policy.


The same could be said for another feature of the president's Affordable Care Act: the state health exchange. That's the online marketplace where individuals and small businesses can buy private health insurance. The law requires every state to have an exchange up and running by 2014.


Just over a week after the November elections, states are required to say whether they plan to run their own exchanges or leave it to the federal government. But some states appear to be waiting until the last minute to give their answer to see who wins the White House.

CORNISH: For a quick check-in on the status of these exchanges, we spoke with Alan Weil, executive director of the National Academy for State Health Policy. He says as of today, more than a dozen states and the District of Columbia say they want to start and run their own exchanges.

BLOCK: Roughly 16 have either said they won't or have shown so little activity that they likely couldn't run an exchange by the federal deadline.

CORNISH: And Weil says the rest fall somewhere in between.

ALAN WEIL: Yeah, there are about 20 states that have been working on building on an exchange but have not made a call one way or the other about whether they will run their own or have the federal government do so. There's also a middle position called a partnership model where the state takes on some of the responsibilities and the federal government takes on others, at least for a year, while they bring these up and then maybe they can make a more informed decision about whether they want to take over full responsibility.

CORNISH: Will it matter to consumers who is running it? You know, at the end of the day, you're just going to a website. Does it matter if the state's doing it or the federal government's doing it?

WEIL: In most respects, I don't think consumers will see much difference between a state or a federally run exchange. If your income changes and you move between, say, Medicaid and eligibility for a tax credit in the exchange, that transition's probably going to be smoother where the state runs the exchange because states already run the Medicaid program. But in terms of the plans being offered, the products, the expectations of the insurance company's accountability to provide services, the transparency of information about what the plan covers, those should be pretty much indistinguishable between a state and a federal exchange.

CORNISH: For states who support the law and are moving forward, can they get their exchange up and running in advance of the deadline if they want to?

WEIL: Well, you can bring up your exchange whenever you want, but the federal tax credits that make coverage affordable to consumers don't start until January 1st of 2014. And one of the things we know from history is that purchasing pools, which is what an exchange is, that don't actually subsidize coverage for people of modest means, they don't tend to work very well because the primary barrier to purchasing health insurance is the price.

CORNISH: In reading about this, there were comments that in states where there's political pressure not to comply with the law, insurance commissioners are almost doing their planning in secret. And I didn't know, as someone who's running, who's part of a think tank, whether you get calls from people who are working on their exchange but don't want anyone to know they're working on their exchange.

WEIL: I interact regularly with people who are working on the exchange who are not in a position to be very public about that work.

CORNISH: So do they call you from an undisclosed location? I mean, how does that work?


WEIL: Well, let's just say that people are careful about what they say and where they present their information. It's not a very pleasant way to go about your daily work. These are, after all, public servants who want to be working in the public interest and view their work as in the public interest. But they're caught between the federal law that their bosses may not be very supportive, but is the law of the land. And the other is a political environment, where activities that implements that law are not well received.

CORNISH: Alan Weil, thank you so much for talking with us.

WEIL: You're welcome.

CORNISH: Alan Weil is executive director of the National Academy for State Health Policy.

Copyright © 2012 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.



Please keep your community civil. All comments must follow the Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

NPR thanks our sponsors

Become an NPR sponsor

Support comes from