In a letter to governors, Health and Human Services Secretary Kathleen Sebelius said she still wants to hear by the end of next week if states will be setting up health insurance markets under the law. But governors can now take another month, until mid-December, to submit detailed blueprints.
The new insurance exchanges will allow households and small businesses to buy a private health plan, and many will get help from the government to pay their premiums. Under the law, states that can't or won't set up exchanges will have theirs run by Washington.
But many governors and state lawmakers were on the fence, awaiting the outcome of the presidential election. And the lost time left them fewer options.
In a concession to procrastinators, Sebelius said states considering a partnership with the federal government to run their exchanges can now have until mid-February to make a decision and submit their blueprints.
The partnership option allows states to handle consumer relations and oversight of health plans, while the federal government does the heavy lifting, taking care of enrollment, and figuring out any taxpayer help that consumers may be entitled to.
Sebelius stressed, however, that she is
"Consumers in all fifty states and the District of Columbia will have access to insurance through these new marketplaces on January 1, 2014, as scheduled, with no delays," she wrote. Open enrollment for exchange plans will start in about 11 months, Oct. 1, 2013.
A check by The Associated Press found 17 states and the District of Columbia on track to setting up their own exchanges, while 10 have decided not to do so.
The states on track include California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington, and West Virginia.
Not setting up exchanges are Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, South Dakota, Texas, Virginia, and Wisconsin. Missouri and others are likely to join the list. The federal government could end up running the show in half or more of the states.