As HIX Deadline Looms, States and Feds Scramble

UPDATED Nov. 13: The deadline for states to submit blueprints for state-based exchanges has been extended to Dec. 14. The deadline for a state to declare it wants to pursue a State Partnership Exchange has moved to Friday, Feb. 15, 2013. The deadline for states to declare whether they plan run a state-based exchange remains Friday, Nov. 16. View details.

The re-election on Tuesday of President Barack Obama removed any lingering doubts about the staying power of the Patient Protection and Affordable Care Act.

With that question settled, states and the federal government are now focusing their attentions on the complex array of programs, policies, and deadlines that will have to be crafted, approved, tweaked, implemented and met before "Obamacare" begins in earnest on Jan. 1, 2014.

The most pressing deadline falls Nov. 16, when states are supposed to submit a "blueprint" of their proposed health insurance exchanges to the Department of Health and Human Services. By some estimates only about 15 states are expected to provide detailed plans for their exchanges by next week, despite having two years to prepare. HHS has said it will operate exchanges in states that cannot or will not do it for themselves but it's not immediately clear how many states that will involve.

"The conclusion we are reaching at this point is probably a couple dozen states will have a significant federal presence," Ceci Connolly, says managing director of the Health Research Institute at PwC.

"Some of them may just defer to the feds entirely and have a federal exchange. Many will have what is being dubbed a partnership model where the feds could be doing a lot of the back office work—technology, infrastructure, records—and the state could handle more of the direct engagement with their citizens, perhaps some of the work around the provider networks in that state that they have a better feel for and have some views on."