Just this week, HHS released its final rule governing exchange creation. The 644-page rule included the word “must” over 1,000 times and “require” more than 320 times. The rule gets so specific as to dictate what items a state must include on its exchange website and how its call center must operate. Under the regulation, any state hoping to create an exchange must first apply to HHS using its “exchange blueprint” template. Secretary Sebelius has sole authority to approve or deny the application. Additionally, any “significant change” must also be approved by the secretary.
The rule itself says that the “minimum functions [outlined in the rule] … are a floor not a ceiling.” Proponents like Merritt argue that if a state doesn’t create an exchange, the federal government will. Under these thousands of pages of regulations and frameworks established by HHS, there is no distinction between the two. States only have the option to further concentrate control in the hands of bureaucrats, not keep it where it belongs: between patients and doctors.
After all of this, even if a state wanted to create an exchange, it would be an almost impossible task. To create exchanges, states must receive approval from HHS by January 1, 2013, which is a little more than nine months away. States would need to rush to create a large Web portal that allows insurers to market their products, helps consumers shop for and purchase insurance and interfaces with various state and federal agencies to provide eligibility and enrollment decisions in hours, not weeks.