Virginia Gov. Bob McDonnell says questions still remain about the implementation of President Obama's Affordable Care Act.
The fight over health care reform is still red hot in Virginia even after the U.S. Supreme Court decision upholding the law. One of the lynchpins in the Affordable Care Act are the health care exchanges available for those seeking insurance coverage.
January 2013 is the deadline for states to start setting up a health care exchange, where people currently without health insurance can browse through their options and find a plan regardless of their ability to pay. These online marketplaces for health insurance are often compared to travel deals sites such as Travelocity.
Though this kind of online comparison shopping may be common in the travel world, the exchange model is a revolutionary concept for health insurance, according to George Mason University health economist Nicholas Len.
"It would shift the balance of transparency and power from insurers to consumers, and that's both why it's controversial and dangerous," Len says. "Both God and the devil live in the details."
Many states have offered stiff resistance, with Texas Gov. Rick Perry (R), Louisiana Gov. Bobby Jindal (R), Wisconsin Gov. Scott Walker (R) and Florida Gov. Rick Scott (R) leading the way in refusing to implement the exchanges.
Virginia, on the other hand, is taking a "wait-and-see approach," according to Jeff Caldwell, spokesman for Virginia Gov. Bob McDonnell.
"The governor wants to ... very prudently move forward ,rather than just jump in and start creating activities that aren't fully thought out or that we don't have all of the information to create," says Caldwell. That means, at least in the short term, the federal government will be creating an exchange for the commonwealth.
"If you prefer having certain decisions at the state level, which often states do prefer, they you'd want to go with the state-based exchange," says Paul Dioguardi, director of intergovernmental and external affairs for the U.S. Department of Health and Human Services. "If you would prefer to cede that authority to the federal government for whatever reason then that's a decision you've got to make."
"I think the important thing to remember up front is that consumers in Virginia won't miss out in 2014 on this opportunity to get this health insurance coverage that they need."
McDonnell is also waiting to see if the outcome of the upcoming presidential election will render the Affordable Care Act moot and the exchanges unnecessary. In a letter to the General Assembly outlining his position on the exchange, McDonnell says it would be a waste of money to invest in a program that will never be implemented if former Massachusetts Gov. Mitt Romney (R) is elected president and overturns the law.
Virginia is one of approximately 12 states willing to let the federal government take the lead in creating the exchanges.