Already several states— New Jersey, South Carolina, Louisiana, among others— have announced they would refuse to set up the exchanges, leaving it in the hands of the federal government. Other states, like Mississippi, are moving ahead to design their own exchanges precisely because they don’t want the federal government to do it for them.
California was one of the first out of the gate to begin setting up an exchange in 2011 following passage of the Affordable Care Act in 2010. (Massachusetts had set up a similar exchange under its own state law passed in 2006). Part of the reason California was ahead of the game was that 18 years earlier it had set up the nation’s first exchange, at its peak enrolling about 150,000 people. It collapsed under financial strain in 2006.
“We are moving from a world where insurance companies once competed by avoiding sick people to one where they compete on service, cost, and quality,” says Anthony Wright, executive director for Health Access, a statewide consumer advocacy coalition.
Peter Lee, head of the California Health Exchange, says with a $39 million federal grant his agency has since hired 40 permanent staff and is on track to be open for the exchange for business in 2013. By January 2014, millions will enroll in insurance that wouldn’t otherwise have access, he says. Currently about one-fifth of Californians are uninsured.