[DonaldC]

So in these states where governors are giving the feds the bird, does that mean citizens are gonna get hosed by the feds for not having gov approved insurance since they won’t be able to buy any on the exchanges?

[trapped_in_LA]

I would bet that the federal government itself doesn’t know what it wants for these exchanges and that in the end they will push off the exchanges while they get their act together. Should be interesting as I’m sure HHS was relying on the States to set these up and does not have the manpower to do it themselves.

[Mrs. Don-o]

I'd be the first to admit that I don't grasp all the complexities here, so if somebody else wants to jump in and do the explaining, go right ahead.

But as I (roughly) understand it, ther are at least two reasons why the states should opt out:

• They want to keep the lines of (ir)responsibility clear. Why should the states put their names, their personnel, their resources into this when it's clearly headed for chaos, cost overruns, and deadline-failure? A state-created exchange is not a state-conrolled exchange: states will not have the power to change anything substantive. So there's no need to become "co-responsible" for the system's inevitable failures: let the whole onus rest on Washington (not on Madison, Nashville and Austin.)
• Plus, there’s still a pending lawsuit that could drastically affect implementation. The way Obamacare was drafted, the subsidies for individuals to purchase insurance apply to state-based insurance exchanges, BUT NOT federal-based ones. In September, the Oklahoma A.G. argued that businesses should not be subject to the $2,000-a-year penalty if it’s a federal exchange with no subsidy. If this case is successful, it would force Congress to reopen Obamacare. For instance, if IL sets up an exchange and MO does not, a favorable ruling in this law suit would mean that MO businesses would be exempted from taxes that would be imposed on businesses in IL. Thus, even Democratic governors would want to see changes in the law.

[ModelBreaker]

“So in these states where governors are giving the feds the bird, does that mean citizens are gonna get hosed by the feds for not having gov approved insurance since they won’t be able to buy any on the exchanges?”

No. The effect of not having a state exchange is that the feds create an exchange in that state. The feds have to pay for the federal exchange. The states have to pay for the state exchange (after a brief period in which the feds take up the cost).

There is also a good argument that the employer penalties under Obamacare cannot be enforced in a state unless there is a state exchange.