LA CROSSE, WISCONSIN (WXOW)-- When the U.S. Supreme Court upheld the majority of the Affordable Care Act this summer, Governor Scott Walker said he would wait until after this year's presidential election before moving forward with the implementation of the law.
So now that the president will serve a second term, Wisconsin and other states have to start setting up health care exchanges. And those states that have not made a decision about how to set up the mandated exchange, have a looming deadline.
"On the 16th we have to, in writing let the federal government know what our intentions are," Governor Walker said.
The exchange is a part of the Affordable Care Act and will likely be an online marketplace for individuals and small business to buy health insurance, so that everyone is able to comply with the individual mandate.
"Once the individual has to buy insurance, that's what the exchange is for," said Michael Richards, executive director of external affairs at Gundersen Lutheran Health System.
States have three options; one is to set up their own exchange.
"A state-based exchange obviously would give the state more flexibility it terms of how they operate their exchange," Richards said. "Up front, there might be some information technology issues they'll have to address. There's also a lot of time and effort that's going to have to be put in to it."
"There's a part of me that looks at a state run one, I don't want to give up anything I don't have to to the federal government, just instinctively," Walker said. "The risk you run, is if a state runs it, money goes away from federal government, you might expose state tax payers to picking up more and more of that cost.
Another option is to allow the federal government to set up and run the exchange.
"In a federal exchange, we'd be subject to whatever the federal government put down," Richards said. "So, what's good for one state, might no be good for Wisconsin."
The last option is a combination of state and federally operated.
And while states must indicate the type of exchange they want to setup by November 16, there are opportunities for adjustments between that deadline and the beginning of 2014, when much of the Affordable Care Act goes into effect.
The state legislature does not have to approve the governor's preliminary plan, which will be submitted Friday. However they are expected to weigh in on the development of the exchange as the process moves forward.
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