Under the Patient Protection and Affordable Care Act, those grants must be awarded by the end of 2014. The deadline set by HHS for applications is Nov. 14.
The only state that appears to be actively considering whether to move forward on an exchange is Illinois, where Democrats control both legislative chambers and the governor's office. Legislation that would allow the state to proceed with a grant application has passed the state Senate. But the sticking point has been the House, where influential Speaker Mike Madigan has shown little enthusiasm for the endeavor. Madigan is often at odds with the state's governor, fellow Democrat Pat Quinn, who faces a tough re-election race this fall.
Jim Duffett, executive director of the Campaign for Better Health Care, which favors a state-based exchange, argues that Illinois could tap $300 million to $500 million in federal grant dollars and create 1,000 jobs if it moves forward. At least 40 House Democrats have signed pledges of support, he said, and they hope to add to that list when legislators return from the Easter and Passover break next week.
“I think we are still at a 50-50 chance,” Duffett said, noting that the Legislature is scheduled to adjourn May 31. “The door's not closed.”
The lack of enthusiasm for creating state-based exchanges undoubtedly reflects the troubles that some states have already encountered in developing their own online marketplaces. In addition to Oregon, Hawaii, Maryland, Massachusetts and Vermont were plagued by major problems with their websites during the 2014 open-enrollment period.
But other state-based exchanges had some of the most robust open-enrollment periods in the country. California, Connecticut, Kentucky, New York and Washington were among the notable successes.
Sonya Schwartz, a research fellow at Georgetown University's Center for Children and Families, has been tracking the issue and points to another explanation as to why states are reluctant to move forward with their own exchanges despite the enticement of federal dollars. “The real reason they won't do it is politics,” Schwartz said. “It's really just political and not whether the federal exchange is any good or not.”