Federally-facilitated Exchanges - Part 1

Link to general guidance on federally-facilitated exchanges  - if a state does not complete the required steps to establish a functional exchange, the federal government will step in and run the exchange for that state.  States can also choose to "partner" with the federally-facilitated exchange by performing some of the functions of the exchange.

States exchange decision progress can be seen here:   http://healthreform.kff.org/the-states.aspx 
And here http://www.statehealthfacts.org/comparemaptable.jsp?ind=962&cat=17

States that have decided not to create a state exchange and will almost certainly have a federally-facilitated exchange as of now are:

South Dakota
Florida
Texas
Louisiana
Maine
South Carolina
Alaska
New Hampshire

States planning for a partnership exchange are:

Illinois
Arkansas
Delaware

States that have made no significant activity towards creating a state exchange are unlikely to be able to successfully establish one by January 2013 and it seems likely that most if not all will have some form of federally-facilitated exchange

Missouri
Georgia
Oklahoma
Ohio
Wisconsin
Wyoming
North Dakota
Kansas

16 States have established exchanges and 16 are studying options. At this point states that are still studying their options are running into limited time to put together the necessary components.

One very important decision about the federally-facilitated exchanges is that they are following the "clearinghouse" model which means every health plan that meets the qualifications for the exchange will be allowed to participate.  This is in contrast with the "active purchaser" model adopted by 7 of the 16 states that have formed exchanges where the exchange will negotiate or otherwise create a competitive bidding process with the potential exchange partipants.  The clearinghouse model is potentially better for the exchange participants in that they will have a higher likelihood of meeting the bar to participation and more control over the pricing and portfolio of plans that they can offer on the exchange. On the other hand there may be more competition and gaming of the market by their competitors which could lead to less predictable or stable results.

Another big question is the benchmark plan used to define the essential health benefits package in a state.