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Pressure on Walker increases over health exchange

Associated Press Published: November 13, 2012
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States that decide to set up their own exchanges have until Dec. 14 to submit details to the federal government.

There are several potential benefits to the state operating its exchange.

The biggest advantage may be that states would be more closely involved with the coordination between the exchanges and their Medicaid programs. Because many people are going to be going back and forth between Medicaid and private coverage in the exchanges, states would likely be better served by being directly involved.

States also can decide whether to allow open access to all insurers, or only work with a panel of pre-screened companies that meet certain requirements.

In addition, the exchanges will offer coverage to people buying in the individual and small business markets, and those are areas that states have traditionally regulated. Without a state-run exchange, states would undercut the role of their own regulators in an important new market.

When the legislation was being considered in Congress, liberal Democrats in the House wanted to have a national exchange administered by federal government. But they were forced to concede the argument to their centrist Democratic counterparts in the Senate, who wanted state exchanges to preserve the state role.

Walker was a staunch opponent of the law and stopped all implementation until after last week's election, on the hopes that Obama would lose and the law would be repealed. But with Obama's victory, and Democrats retaining control of the U.S. Senate, the pressure is now back on Walker to make a decision about moving forward.

Walker has also declined to expand Medicaid coverage as allowed under the law. The U.S. Supreme Court in June made that expansion — which could make coverage available to about 170,000 people in Wisconsin — optional with no deadline for deciding.

A recent AP poll found that 63 percent of Americans want states to run the exchanges, with 32 percent favoring federal control.

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Associated Press writer Ricardo Alonso-Zaldivar contributed to this story from Washington, D.C.