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The Washington PostAcross the country, states are lagging in preparations to erect the health insurance marketplaces at the heart of the 2010 health-care overhaul, bogged down by a combination of partisan hostility and practical hurdles.
Faced with the delay, administration officials have been ramping up talks with state leaders in recent weeks over ways the federal government could pitch in without having to completely take over — speaking both informally and at a series of regional meetings underway.
The private discussions are evolving, with a range of federal-state partnership arrangements under consideration. But analysts on both sides of the health-care debate say one thing appears increasingly certain: The system of 50 completely state-operated insurance markets envisaged by the law is not what Americans will encounter when these “exchanges” open for business in 2014.
“When this law was passed in the spring of 2010, people really believed the states would get on board and we would see almost all exchanges being state-run,” said Timothy Jost, an expert on health policy at Washington and Lee University who supports the statute. “But there is a growing concern that quite a number of states will not be ready.”
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http://www.washingtonpost.com/national/health-science/as-states-lag-in-implementing-health-care-law-bigger-federal-role-looks-likely/2011/08/29/gIQA8k6ZIK_singlePage.html