But Ari Adler, press secretary for House Speaker Jase Bolger, said the Michigan House does not plan any further hearings on the exchange. "The governor is working with the federal government to establish a state-federal partnership for an exchange in Michigan," Adler said. "At this time, we don't believe any action by the Legislature is necessary."
Kluge said she and association executives are meeting with key Republican legislators to change their minds.
"It's not too late. A federal-state partnership exchange could cost Michigan more than a state-run health exchange," said Kluge, noting that the federal government would finance the first year's operations of a state-run exchange. A state-run exchange would need to be financially self-sufficient by the second year.
"We also would lose control with a federal-state exchange," she said.
But Steve Hilfinger, director of the Michigan Department of Licensing and Regulatory Affairs, said it is unclear whether the federal government would help Michigan pay for staff to provide customer assistance for people purchasing health insurance on the exchange. "We are studying all of this … how it would get funded. We are waiting on further details from the federal government," Hilfinger said.
A health insurance exchange, which is a key provision of the Patient Protection and Affordable Care Act of 2010, would allow individuals and small-business employers to comparison shop among private insurance plans through a web-based portal.
The federal law allows exchanges to be initially open to employers with 100 or fewer employees.
Last November, the Michigan Senate approved Senate Bill 693 to set up Michigan's exchange. House Republicans held several hearings but decided not to consider the measure until after the Nov. 6 presidential election. The federal government has given states until Nov. 16 to submit a plan to run the insurance exchange on their own or apply for a federal-state partnership.
Late last month, Gov. Rick Snyder said he would apply for the partnership exchange after failing to convince House Republicans to approve the Senate bill that would allow the state to run its own exchange. Snyder decided the state did not have enough time or funding to conduct the planning.
House Republicans also balked at using $9.8 million in federal funding to further develop the infrastructure for the exchange.
Hifinger said Snyder continues to favor a state-run exchange and hopes the House approves the $9.8 million for the exchange. He said those funds, if appropriated, could be used to defray Michigan's first-year costs to run the exchange.
"We would like to get the $9.8 million to continue to study this, but we have focused planning on the federal-state exchange," Hilfinger said. "Given the schedule now, we are not sure we could pull it off for 2014. Maybe down the road, in 2015, we could move to a state exchange."
Under a partnership exchange, Michigan could be in charge of certifying health plans that sell their products on the exchange and could perform consumer assistance services. "We already do health plan management through OFIR (Office of Financial and Insurance Regulation)," Hilfinger said. "It would not cost us any more to do this under the exchange."
Michigan would retain Medicaid eligibility determinations and use the information technology developed for the exchange to simplify and speed the approval process.
Laura Appel, vice president of federal policy and advocacy with the Michigan Health and Hospital Association, said the additional $9.8 million would be helpful for the state to complete the necessary documents by Nov. 16 to apply for a federal-state partnership or to establish a state-run exchange.
"The application is pretty extensive. It is more than just submitting a letter. You have to declare what you want and then say how you are going to do plan management," Appel said. Appel said the Legislature could authorize appropriation of the $9.8 million without approving SB 693, which authorizes creation of the state-run exchange.