Sarah Kliff at the Wonkblog finds a good nugget in a new White House report on the status of implementation of the insurance exchanges provision of the Affordable Care Act in the states.
First, from the Kaiser Family Foundation, where a snapshot of where the states are in the process:
The Obama administration has spent $729 million laying the groundwork for health insurance exchanges, according to a White House report published this morning. That number will likely tip over $1 billion in the coming months, as states continue setting up the new marketplaces where Americans will shop for health insurance beginning in 2014. As the above map from the Kaiser Family Foundation illustrates, states are pretty much all over the place on exchanges right now. Fourteen have established marketplaces and another five intend to do so. Then, there are the less active states: 22 states continue to study their options, while two have decided not to do anything at all.
The report shows what the administration’s spending has purchased: Buy-in on implementation from states that aren’t exactly fans of the Affordable Care Act. Twenty-eight states have received multimillion-dollar “exchange establishment” grants to get started on the heavy lifting of building a health insurance marketplace. Half of those states have Republican governors, a few of whom have embraced the idea of health insurance exchanges enthusiastically. [...]
Ultimately, we’re seeing a rift within the Republican party over whether to implement the health insurance exchanges. Some support implementing the law and retaining more power as it moves forward, as the federal government can step in and set up exchanges in states that don’t move forward on their own. Other states, however, want to completely opt of implementing a law they believe to be unconstitutional.
Of course, then there are states like South Carolina, where Gov. Nikki Haley took the money—$1 million—to do the study on setting up an exchange, but dictated the outcome of that study to the panel, saying in an e-mail, "The whole point of this commission should be to figure out how to opt out and how to avoid a federal takeover, NOT create a state exchange."
A few of the states, including Florida, Louisiana and Texas, which are participating in the law suit challenging the constitutionality of the ACA, have refused to begin the work to set up the exchanges. Others, like Idaho (which is highlighted in that White House report) are moving forward, anyway. What's ironic for those states refusing to set up the exchanges is that they're inviting greater federal government intervention. The law stipulates that the federal government set up exchanges for residents of states where the state government fails to do so.