DETROIT (AP) — Michigan Gov. Rick Snyder's administration declared this week the state has run out of time to create its own online health exchange and must take a back seat to a federally run program.
It ends months of efforts by the Republican governor to get fellow GOP leaders in the Michigan House of Representatives to approve a state-driven website for comparing and buying health insurance plans. As deadlines pass in the long rollout of the federal Affordable Care Act, experts say not to expect any final decisions soon by states about setting up the required exchanges, as many hedge their bets and hold their breath before the November election.
States have the option of creating their own exchange, teaming up with the federal government or having a federal system. More than 500,000 Michigan residents are expected to buy private insurance through the exchange once it's up and running in 2014, including some who already have coverage.
Michigan joins only three other states so far that are planning for a federal partnership, according to data compiled by the foundation. As of Aug. 1, 16 states have established their own exchange and about half as many have decided against it. The foundation also found 16 studying their options and no significant activity in nine states.
"I don't think we'll see a lot of additional states moving ahead with implementation between now and November," said Larry Levitt, vice president for special projects with the nonpartisan Kaiser Family Foundation, an information clearinghouse on the U.S. health care system. "I would not be surprised to see a lot of discussions among states and the federal government the day after the election if the president is re-elected. I would suspect a strong push by the states to do whatever they can as quickly as they can."
Levitt, who served as a senior health policy adviser in the Clinton administration and was involved in the development of a health care overhaul that failed in Congress, said "in most places it's remained quite partisan." And in those places, the November election represents a referendum on the health care law as well as President Barack Obama.
"In many states, it's come down to a debate over whether to help implement 'Obamacare' or not, rather than a discussion based on the assumption that the health care law is being implemented and a judgment about the best way to do that," he said. "Where you come down on it is in part determined on whether you're willing to concede that the Affordable Care Act is going to happen."
Michigan House Republicans had hoped the U.S. Supreme Court would strike down the federal health care law, but the court in June upheld most of it. Some lawmakers have said any action on the exchange should be delayed until November because if GOP presidential candidate Mitt Romney wins the White House and Republicans capture the U.S. Senate, some parts of the health care law could be repealed.
Snyder tried to sway fellow Republicans that the state would be better served with its own exchange rather than the federal government making those decisions. The Republican-controlled Michigan Senate approved the exchange last year, but the House has balked because members fear such an agreement could hurt them this November with voters who object to government control.
Ari Adler, spokesman for House Speaker Jase Bolger, said a "lack of consistency in information provided by the federal government" on matters such as how the exchange will work led House leaders "to demand more solid answers before proceeding."
Snyder's spokeswoman Sara Wurfel called the decision "unfortunate" but necessary because of the House's inaction. Wurfel said the next step for the state is to notify the federal government by Nov. 16 of its intentions to pursue a partnership, which does not require legislative approval or executive order.
The Kaiser foundation's Levitt said the challenge for states who haven't signed on to any approach will be trying to catch up after the election. States likely will have to accept a federal program for a year and then work on implementing their own or teaming up with Washington, he said, but he doesn't rule out some federal wiggle-room.
"I wouldn't be surprised to see some flexibility by the federal government for state involvement — they would try and make that work in any they could," he said. "They really just want to get it done."