Like it or not, states are finally in business – the exchange business

December 7, 2012


See my closing comments in Devin Leonard’s story “Obamacare: For State Republicans, It’s Decision Time” in Bloomberg Businessweek’s Politics & Policy section

In today’s Bloomberg Businessweek’s Politics & Policy section, Devin Leonard writes on several Republican-headed states that are making some tough decisions on their states’ exchanges right now.

After health care reform was upheld by SCOTUS this summer, many states decided to wait until the election, leaving themselves precious little time to prepare for announcing whether they would run their states’ own exchanges if Obama won.

So as I point out at the end of Leonard’s story – Obamacare: For State Republicans, It’s Decision Time – give it a minute.

The afterglow of the elections will fade away along with the pre-election rhetoric on repeal and replace. Even though states that were on the health care reform offensive will be starting behind the curve – they’ll get there.

You have to ask, does the Governor Perry really want the Federal government running the Texas exchange? “Not for long,” is the most likely answer.

Look to states on the Federal exchange to start setting up bridge strategies to take their exchanges over. Many decisions will be based on their own state-specific circumstances.

States will also be getting a second cut at rebuilding their Medicaid IT infrastructure through its expansion. They’ll get to upgrade legacy systems developed in the Vietnam era, some of which are running on COBOL. There have already been some signposts that officials of states not initially signing on to the Medicaid expansion may be campaigning for it to relieve the pressure they’re now under, like in the Dallas–Fort Worth area.

Once we get past the optics of saying they’re against Obamacare, I believe that even Republican-led states will get there. There’s nothing like a new year to put a different spin on things.

In 2013, I expect that states currently holding out on running their own exchanges will take a fresh look and consider starting a legislative process to build, own and control their own.

Read more

For regular commentary on developments and trends in health care, technology and insurance, follow @brycewatch and @ExtendHealth on Twitter and check out

One Response to “Like it or not, states are finally in business – the exchange business”

  1. ehmktg said

    Reblogged this on The Extend Health Blog and commented:

    Great post on state exchanges and links to some interesting articles, including comments from Bryce Williams in Businessweek’s “Obamacare: For State Republicans, It’s Decision Time.”

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