One of the 2010 Affordable Care Act's most ambitious deadlines deals with these marketplaces, known as "exchanges." States are directed to build their own versions.
If they don't make significant progress by Jan. 1, 2013, federal officials can step in with a fallback exchange. Exchanges must be operational by Jan. 1, 2014.
It's clear to anyone following this issue that Republicans tend to believe the feds won't step in quickly -- or won't be ready to do so. Democrats usually take the deadline more seriously.
In Minnesota, that's been a key reason why the Dayton administration has pushed so hard to develop the exchange even as GOP legislators failed to act on it last year.
Meanwhile, in Wisconsin and South Dakota, Republican governors recently suspended critical work on exchanges until after the U.S. Supreme Court issues its ruling on the health care reform law.
A recent story by the respected Kaiser Health News service suggests that the feds won't be waiting to swoop in with fallback exchanges at the crack of dawn on Jan. 1.
While 28 states have made good progress in setting up exchanges (Minnesota among them), according to a recent White House report, that still leaves 22 states that haven't, including several that have flat-out refused to do so.
Setting up an alternative exchange for just a handful of states, much less 20 or more, would be a "herculean task" said Robert Laszewski, a well-known consultant and former insurance executive quoted by Kaiser.
The U.S. Department of Health and Human Services did not respond to Kaiser Health News' requests for comment on the issue. The HHS, however, is spending a lot of money to build a federally facilitated exchange for states that aren't ready.
The feds have signed $150 million in contracts with vendors to make it happen, and exchange guidelines recently issued by the agency suggest it is serious about the deadline.
John McDonough of the Harvard School of Public Health told Kaiser Health News that he's had conversations with the administration and that it is "hell-bent" on getting the exchanges operational by 2014.
Jill Burcum is a Star Tribune editorial writer.
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