One of the last holdouts among prominent Republican governors, New Jersey Gov. Chris Christie, put his state among a growing number that will defer to the federal government to run the health insurance marketplaces that are a key provision of the Patient Protection and Affordable Care Act.
The picture of which states would participate in providing tightly regulated individual and small-group coverage through the exchanges beginning in 2014 has rapidly clarified since the Nov. 6 election.
Under a Dec. 14 deadline to notify the Obama administration of plans to establish a state-based exchange, 21 states have indicated they will not form their own exchange. In states that decline, HHS will operate an insurance marketplace on its own or in partnership with state officials.
Like many of his peers, Christie complained that HHS has failed to provide states enough guidance to allow them to responsibly carry out the provision. "We will comply with the Affordable Care Act, but only in the most efficient and cost-effective way for New Jersey taxpayers," Christie said in a news release announcing the decision to veto legislation that would have started establishing a state-based exchange. "I will not ask New Jerseyans to commit today to a state-based exchange when the federal government cannot tell us what it will cost, how that cost compares to other options and how much control they will give the states over this option that comes at the cost of our state's taxpayers."