Despite the task ahead, the Obama administration insists that it will get the exchanges up and running by Oct. 1.
"No matter where a qualified consumer lives, he or she will have access to coverage through a marketplace," Sebelius said in a recent blog post.
State vs. federal exchange
Consumers looking to buy coverage through that marketplace may not be able to tell whether it's a state or federal effort.
"I think it will look like a state exchange to anyone. They won't necessarily know," said Sonya Schwartz, project director of State Refor(u)m, an online network for health reform implementation developed by the National Academy for State Health Policy in Washington, D.C.
There will be clear distinctions, though. Some state exchanges have adopted an "active purchaser" model, meaning they will limit consumer choices to health plans offering the best value. The federally facilitated exchanges, by contrast, will include all qualified health plans in a state.
"The other thing is, I think that consumers do probably have a better chance of getting their complaints or problems addressed in state-exchange states," Schwartz said. In states with federally facilitated exchanges, she explained, "people will still go to their state officials, and officials won't really know how they can help, necessarily."
State-run exchanges may also have a leg up when it comes to spreading the word to people who need health insurance. "Everybody's going to have to be engaged in reaching those people and educating them," de Percin said.
The Henry J. Kaiser Family Foundation has mapped out state exchange decisions.
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