STEVE INSKEEP, HOST:
Some states didn't wait till that deadline. Right after the presidential election, Missouri Governor Jay Nixon announced his state would not be setting up its own exchange. Next door in Kansas, Governor Sam Brownback made a similar announcement. Saying no, however, has a consequence. When states decided not to set up health exchanges, the federal government will do it for them. Elana Gordon from member station KCUR reports.
ELANA GORDON, BYLINE: President Barack Obama's health law has never had an easy time in this part of the country and it's still not going down very well. Kansas Governor Sam Brownback announced a few days after the election his state would not have any involvement in setting up or managing a health exchange. Sherriene Jones-Sontag is the spokesperson for Brownback's office.
SHERRIENE JONES-SONTAG: Kansans feel Obamacare is an overreach by Washington and have rejected the state's participation in this federal program.
GORDON: Next door in Missouri, the law has also faced an uphill battle. Last week, voters overwhelming approved a measure prohibiting the governor or any state agency from making any moves towards setting up an exchange without legislative approval. And lawmakers don't convene again until January well past some of the key deadlines. Governor Jay Nixon, a Democrat, said all of this means is that Missouri will have a federal exchange.
GOVERNOR JAY NIXON: Based on current state law and the federal deadline, the state-based option isn't on the table for Missouri at this time.
GORDON: Some health policy experts find the situation in Missouri ironic. Thomas McAuliffe is with the Missouri Foundation for Health, which has helped fund efforts to plan an exchange.
THOMAS MCAULIFFE: We have a state that is very much committed to state's rights and state control, yet we're willing to just blindly seed all creation and administration of our health-based exchange or our insurance state marketplace to the federal government.
GORDON: But McAuliffe doesn't want to write everything off just yet. He thinks states like Missouri are likely to become more involved in the process as the political dust settles. Governor Nixon himself said in his announcement that falling back on a federal exchange isn't ideal.
NIXON: Regulating the insurance market is a power best left in the hands of the states, but we can perform those duties more efficiently and effectively and provide better service for our consumers.
GORDON: Early on, Missouri had made some progress towards setting up an exchange, as had Kansas. That's come to a halt in both states. But there are still those like Kansas insurance commissioner Sandy Praeger who want the state to be involved in a hybrid state/federal partnership. Praeger says that will depend on the path Governor Brownback takes with his new legislature in the months ahead.
SANDY PRAEGER: His concern is that they have all these new conservative Republicans that won't want to go along with a partnership exchange, but, you know, I'm still hopeful. I'm still hopeful.
GORDON: The Missouri Foundation for Health's Thomas McAuliffe says by extending the deadline for state to declare whether they will run an exchange or not, the federal Department of Health and Human Services is signaling a bit of desperation.
MCAULIFFE: This is an indication to me that Health and Human Services, i.e. the Obama administration, is dying for state support on this. Their worst case scenario is, is that they set up nearly 30 federal-based exchanges.
GORDON: And what that means, he says, is that states like Kansas and Missouri will still have an opportunity to get more involved if they choose to. No matter who's in charge, the reality is all these exchanges have to be up and running in a little over a year. That's not a lot of time for either federal leaders or the healthcare industry to work out the details and make sure everything's ready. For NPR News, I'm Elana Gordon in Kansas City.
INSKEEP: This story is part of a partnership with NPR, KCUR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.