Even Reluctant States Design Health Insurance Exchanges

Virginia Republican Governor Bob McDonnell wants the U.S. Supreme Court to strike down the 2010 health-care overhaul. That hasn’t stopped him from taking $1 million from the federal government to uphold one of the law’s top provisions. Virginia is using the money to help design a statewide market, or exchange, where uninsured people and small businesses can buy health coverage, starting in 2014. Under the law, if a state hasn’t drawn up plans for its own exchange by next January, the administration will build one for its residents instead.

McDonnell’s hold-your-nose-and-hedge approach represents a middle ground among governors and legislatures responding to the overhaul. A handful of states led by Democratic governors has embraced the law and are rushing to set up exchanges. A handful led by Republicans wants nothing to do with them. More than half, including Virginia, are creating exchanges without committing to run them, waiting to see what the high court says. “We’re trying not to lose any time if the Supreme Court decision doesn’t go the way the governor would like it to,” says Cindi Jones, Virginia’s health-reform director.