The federal government will run more health insurance exchanges as they come online next year than states. On Friday, both Virginia and Florida rejected running their own exchanges, just hours before the midnight deadline for states to officially declare whether or not they would set up their own insurance exchange or get some amount of help from the federal government.
Florida's refusal isn't too shocking considering Republican Governor Rick Scott had been a vocal critic of the Patient Protection and Affordable Care Act.
Virginia's Governor, Bob McDonnell, rejected setting up a state-run exchange, and sent a letter to Department of Health and Human Services Secretary, Kathleen Sebelius on Friday. McDonnell indicated his decision was based, in part, on what he characterized as the federal government's lack of direction and information.
"Originally, I asked that we begin the planning process to potentially operate a state-based exchange for Virginia, primarily so we would be in control of this process," wrote McDonnell. "However, despite repeated requests for information, we have not had any clear direction or answers from Washington until recent days, and we cannot conclude, as we review those materials, that we would have the control and flexibility needed to efficiently and effectively run our own state exchange."