Feds build health care markets

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WASHINGTON — Don’t look now: The feds may be gaining on GOP governors who’ve balked at carrying out a key part of President Barack Obama’s health care overhaul law.

Opponents of the law say they won’t set up new private health insurance markets called exchanges. But increasingly it’s looking like Washington will just do it for them.

That means federal officials could be calling the shots on some insurance issues that states traditionally manage, from handling consumer complaints to regulating plans that will serve many citizens.

Unless Mitt Romney wins in November, that could turn into a political debacle for those dug in to fight what they denounce as “Obamacare.”

“You’re kind of rolling the dice if you think (Obama’s health care law) will go away,” said Kansas Insurance Commissioner Sandy Praeger, a Republican.

If Romney can’t make good on his vow to repeal the overhaul, “you are just giving up a lot of authority.”

The law envisioned that states would run the new markets, or exchanges, with federal control as a fallback only.

But the fallback now looks as if it will become the standard option in about half the states — at least initially.

It would happen through something called the federal exchange, humming along largely under wraps on a tight development schedule overseen by the Health and Human Services Department in Washington.

Exchanges are online markets in which individual consumers and small businesses will shop for health insurance among competing private plans.

The Supreme Court’s health care decision left both state exchanges and the federal option in place.

The exchanges are supposed to demystify the process of buying health insurance, allowing consumers to make apples-to-apples comparisons.

Consumers will also be able to find out whether they’re eligible for new federal subsidies to help pay premiums, or whether they qualify for expanded Medicaid.

It’s all supposed to work in real time, or close to it, like online travel services. Open enrollment would start a little over a year from now, on Oct. 1, 2013, with coverage kicking in the following Jan. 1.

Eventually more than 25 million people are expected to get coverage through exchanges, including many who were previously uninsured.

As exchanges get more customers, competition among insurance plans could help keep costs in check.

But only 14 states and Washington, D.C., have adopted plans for their own exchanges: California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington and West Virginia. And some could still backtrack.

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