Only some states have set up their health care exchanges.

States shouldn't be in a hurry to begin working on the Patient Protection and Affordable Care Act exchanges.

That's the viewpiont of many states (not Michigan) and of J.P. Wieske, legislative liaison for the Wisconsin Office of the Commissioner of Insurance.

"For us, the issue is whether or not it's good public policy to move ahead," Wieske told Capitol Confidential. "Our view is that it is more prudent to wait and see what happens."

Under the act, which is commonly known as Obamacare, states can develop their own exchanges. It has been argued that if states don't act first, the federal government could do it instead.

Michigan Gov. Rick Snyder is among those making that argument.

"Now that the Supreme Court has essentially upheld the ACA, the governor believes it's important to move forward on the MiHealth Marketplace and ensure that we create a Michigan solution rather than the feds imposing one and making those decisions for us," said Gov. Snyder's press secretary Sara Wurfel. "He's said that, while it's possible that post election the ACA will be repealed and that Washington will change course, we cannot bury our heads in the sand until that day comes for a variety of reasons (harness federal dollars, avoid unnecessary costs, be fiscally responsible, protect Michiganders and job providers, etc).

"We're working with lawmakers to help address and resolve additional questions and concerns so they are assured this action would be in the best interest of Michiganders," Wurfel said.

However, Wieske said there are many variables of what might happen that moving ahead now doesn't make sense.

"There are a lot of pieces of this," Weiske said. "First, we don't know what's going to happen in the election. Who is going to be president? Are we going to have a Republican-controlled Senate? A lot is going to depend on the outcome. There are all sorts of variables.

"Even more importantly, we don't know where the federal government is going to be regarding support for state exchanges," Wieske said. "Will it be supportive of state exchanges or more supportive of a federal exchange?"

When asked if the federal government would even be able to have an exchange ready by the scheduled deadline of October 2013 Wieske said he wasn't sure.

"Well, we'll see," Wieske said. "This administration has had a way of repeatedly moving the goal posts back. So, that could happen again.

"They are talking about taking Medicaid out of it," Wieske said of the federal exchange rules. "If they did that they could conceivable have it ready on time. If they include Medicaid, they'll have a lot of difficulty dealing with it."

Wieske said state lawmakers across the nation are feeling pressure to move ahead with the state exchanges.

"We've seen a lot of angst among Democrats and consumer groups on this issue," Wieske said. "There are a lot of so-called good reforms in the legislation. But in Wisconsin we already have many of these reforms and I think that's probably so in many other states. Some of these were already accomplished through HIPAA (Health Insurance Portability and Accountability Act).

“They (consumer groups) are also afraid of the job loss issue," Wieske said in regard to the distinctions between a state exchange and a federal exchange. "That could be overstated, but it would be untrue to try to claim there is no potential job loss issue involved."

A more complete presentation of Gov. Snyder's arguments has been made available.

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See also:

Michigan Capitol Confidential Obamacare Coverage

Commentary: Health Care Exchange Issue Won't Go Away

Official Calls Obamacare Implementation “A Mess”

Commentary: Two Reforms to Really Fix Health Care