(link...)

According to that article, the deadline for states to notify DHHS of their intent is still Friday. The extension is for states to file their exchange "blueprint" plan.

So they have three weeks to finish two years worth of homework. Republicans keep wanting to get in government office but then find out they have to actually work and stuff.

Congress did its part. DHHS did their part. The voters have done their part. Too bad the election didn't turn out like the state Republicans wanted, because now they have to do their part. Or do nothing and punt.

Let's see: we don't like Obama and his stinking law so we'll refuse to set up an insurance exchange. And then the Feds will do it for us.

Oh, wait....

Quite a quandry they're in, isn't it?

Okay, so to dumb it down a little, Haslam has until Friday to either submit TN's intent to set up a state exchange, and if he doesn't, TN is automatically enrolled in the federal program, right? And if the intent to self-run is made known on time, TN has three weeks to get a basic framework plan ready? What happens if that blueprint isn't ready in time? Are all the deadlines of the "have X ready or you're switched to the federal exchange" variety, or is there a point at which the state can postpone and waffle and hem and haw?

Their recommendation was to "Continue to advocate for the overturning and/or repeal of the PPACA" and to delay implementation awaiting "clarity of 2012 events" (i.e. the election.)

There was also the NFIB Supreme Court decision.

My guess is that they really didn't have an alternate plan.

I'm old enough that my memory does occasionally fog on some issues, but as I recall, we jumped head long into managing our own Medicaid program under a previous administration and managed to botch it thoroughly in relatively short order, causing numerous people to lose much needed coverage and so on.

What makes the Governor think we'd be any better at self-management now than we ever were?

Republican Gov. Bill Haslam says Tennessee could design its own health insurance exchange required under Democratic President Barack Obama's health care law, but resistance in the GOP-controlled General Assembly may cause the state to hand that power off to the federal government

"Could" means they haven't. "Resistance" means they won't.

The feet dragging is just a ploy of the Governor to keep his further Right at bay.

Do we really want a state exchange?? Especially one that has been cobbled together in 3 weeks?

Maybe Haslam is doing the right thing like he did with the city pension. Pass it along to people who know what they are doing and have the time to deal with it.

Since the state already administers the Medicaid/TN Care program with Federal money,and the new Healthcare program is to accomodate everyone, does that mean that, if the Federal takes over setting up the healthcare program, it will take the money it is now sending to the state and add it to the Tennessee Federal healthcare program?

It would serve the state Legislature right if they no longer get to handle the current amount of Federal money they receive for the TN Care program.

There is a relationship between state Medicaid/CHIP programs and the health insurance exchanges. From what I understand, states are required to have a consolidated eligibility and enrollment process for Exchange Qualified Health Plans, Basic Health Plans, Medicaid and CHIP. Presumably this is intended to get enrollees in the right program.

Another issue involves people transitioning from one type of eligibility to another based on changes in income, marital status, household makeup, etc.

From what I've read, the PPACA envisioned that states would at least consider using their existing state Medicaid administrative infrastructure and provider relationships to implement exchanges, provide seamless transition from one program to another, monitor compliance and control fraud and abuse.

Here's a report outlining some of the issues.

It's not clear how the Supreme Court decision to allow states to opt out of Medicaid expansion affects the overall policy, or how a federal exchange would work for a state without expanded Medicaid coverage in regard to eligibility, etc.

Here's another interesting report on Maryland's blueprint for implementing exchanges.

In addition to making your head hurt, reading this stuff is a reminder that delivering social services is complicated business. It's probably more complicated than running a chain of truck stops, and above the pay grade of agency appointee buddies who donated a lot to the ET Foundation or the UT Skybox program.

It's also a reminder that all this complexity involving a hodgepodge of programs could be eliminated with single-payer Medicare for all.

Also, where's ALEC's model legislation to help states implement exchanges? Oh, wait...

KNS Editorial: Tennessee should take charge of its Affordable Care Act insurance market

Possibly in an effort to not be a one-term wonder, FL Governor Rick Scott drops opposition to Obamacare

"The election is over and President Obama won," Scott said. "I'm responsible for the families of Florida ... If I can get to yes, I want to get to yes."

RGA: Seriously, ya'll. We're all in Vegas putting together our gameplan to "lead from the states."
Sebelius: letters of intent and applications by December 14

Reminder: ANY STATE CAN REPEAL AND REPLACE OBAMACARE IN 2014. Tennessee's Republican ubermajority can put up or shut up at any time with a plan of action, thanks to the Wyden amendment.

Really? Yes. You got an updated State Innovation Waivers memo back in February.