The 18 states that have opted to build their own exchanges are California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Vermont, Utah, Kentucky, Colorado, New York, Connecticut, Massachusetts, Maryland, Oregon and Washington.
Other states are opting out, with governors from many of those states citing the ongoing expense of operating and maintaining the exchanges as a key reason. Arizona Gov. Jan Brewer said her state would be saddled with up to $40 million in annual expenses to operate an exchange after federal subsidies expire in 2015.
Delaware is one of only seven states to have committed to a federal partnership as of late January. The head of the state agency overseeing that partnership spoke with HealthLeaders Media about the benefits and challenges of the new insurance model.
After the February 15 deadline, the federal government will set up exchanges for the states. While it's not clear how the federal option will work, it seems likely they'll operate through a single portal where consumers can log on, choose their state, and browse through a list of insurers and health plans available in their area.