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Many states have to enact legislation authorizing the establishment of an exchange
WASHINGTON-Many states have to enact legislation authorizing the establishment of an exchange to market health insurance and to address basic governance policies and structural issues. States must decide whether an exchange will be open to all plans, or just those that meet set criteria.
Government grants will help states develop exchanges, and 49 have cashed in so far (Alaska is the exception). For most local officials, though, the cash barely makes a dent in the resources needed to tackle these projects.
Despite uncertainty created by pending court challenges and opposition to reform from Republicans, state agencies continue to implement the legislation. Most are not talking about defaulting on exchanges and letting the Feds run the show.