Implementing Reform: Funding and Flexibility for States on Exchanges

Timothy Jost

Posted 10/30/11 on The Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

As 2011 comes to a close, we draw ever closer to January 1, 2014, the day when the most significant changes wrought by the Affordable Care Act will come into effect.  Indeed, we are only weeks away from the halfway point between March, 2010, when the ACA was signed into law and October, 2013, the date when the exchanges will open for enrollment.

Yet few of the states seem to be halfway there.  A few states have indicated that they will not be establishing exchanges under any circumstances, but more exchanges are simply stalled in the state legislative process, held up by stiff opposition to reform or by inertia and tight legislative calendars.  Some states are also sitting it out, hoping that the Supreme Court makes the whole statute go away (which is, in fact, almost inconceivable as a legal matter).

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