Republicans working on exchanges have been accused of party disloyalty, and that opposition has intensified after the Supreme Court upheld the Affordable Care Act in late June.
In Colorado, Tea Party members tried to expunge Republican Amy Stephens for co-sponsoring exchange legislation. In Michigan, the conservative advocacy group Americans for Prosperity circulated petitions to kill proposed exchange legislation. In Ohio, Republican governor John Kasich has stepped back from initial support for a state exchange.
“Even the conservatives, given the option from having some control to no control, they’d prefer to have some control. But until this election is behind us, they’re not willing to do anything that would show they’re supporting Obamacare. And that’s the same situation a lot of states are in,” said Sandy Praeger, Kansas’s insurance commissioner.
Joel Ario, who until last year ran the federal government’s office of insurance exchanges, said he was once asked how many states had refused to discuss the program as their leaders battled the healthcare law.
“The answer was zero,” said Ario, now managing director at Manatt Health Solutions. “Every state insurance department is engaged. (Though) if you called all of them, some of them might deny it.”
Some states manage to find alternative outlets. New York’s Democratic governor Andrew Cuomo created an exchange via executive order, bypassing the Republican-controlled Senate.