Most States Shun Fed HIX Partnerships, But Seek Accommodations

"It is definitely a lot lower than what policymakers envisioned when the law was passed." Pearson is tracking the implementation of the Patient Protection and Affordable Care Act at the state level.

There are no real surprises on the list of states pursuing a federal partnership model. Delaware was an early adopter to the idea, and the others all indicated earlier they would follow suit.

The bigger surprise comes from Virginia and Ohio. Both states are defaulting to a federally run exchange while at the same time indicating they will continue to oversee plan management activities, which is a key characteristic of a partnership arrangement. Confused? So is Pearson.

"The whole thing is a bit befuddling," she says. "Much of the responsibilities that they are citing they want to maintain control over are things that are components of that partnership option."

Virginia's legislature is on track to pass a bill giving its insurance department the authority to collect information on plan rates and benefits, ensure compliance, resolve customer complaints, provide technical assistance and decertify providers who participate in the federally run exchange.