Arizona won't help implement a key component of President Barack Obama's health care reform law, Republican Gov. Jan Brewer said in a letter to a federal health official Wednesday.
Including Arizona, there currently are 17 states that won't create so-called health insurance exchanges -- online marketplaces where uninsured people and small businesses will choose health plans and learn whether they're eligible for tax credits. Thirty million people are expected to gain health coverage through the exchanges by 2022, according to the Congressional Budget Office.
Brewer blamed the Obama administration for her decision. "The state of Arizona has made significant progress in its planning and design configuration for all of the required health insurance exchange core functions," Brewer wrote to Gary Cohen, the director of the federal Office of Consumer Information and Insurance Oversight. The administration failed to issue regulations or provide detailed information to states fast enough, she charged. The health insurance exchanges must be operational on Oct. 1, 2013, when millions of people are expected to use them to shop for coverage for the following year.
Although the federal government has the authority to step in and create exchanges in states that don't build their own, lack of cooperation from states could hamper how well they function, and how many uninsured people get coverage.
Brewer reiterated her "unwavering" opposition to Obama's 2010 health care reform law, but said in a written statement that "this has been one of the more difficult decisions in my career in public service." By rejecting a state-run health insurance exchange, Brewer is ceding control of the new Obamacare insurance market in her state to the federal government. "Though I am a steady advocate of local control, I have come to the conclusion that the state of Arizona would wield little actual authority over its 'state' exchange," she said in the statement.
The Obama administration last week published several critical regulations governing what benefits must be covered by health insurance sold on the exchanges and establishing consumer protections, such as a ban on discriminating against people with pre-existing conditions.
Like Brewer, other governors have complained they had to wait too long for federal regulations they needed to help evaluate their options. However, 17 states and the District of Columbia moved ahead with plans to create their own health insurance exchanges even without those federal rules in place. Six states will manage exchanges jointly with federal authorities and the remainder have until Dec. 14 to declare their plans, according to the Henry J. Kaiser Family Foundation.
Brewer's decision comes soon after a slew of announcements from other governors, mostly Republican, earlier in November. Oklahoma Gov. Mary Fallin (R), Texas Gov. Rick Perry (R) and Wisconsin Gov. Scott Walker (R) all have rejected building health insurance exchanges in their states.
In addition, eight governors, including Perry and Fallin, say their states won't participate in the health care reform law's expansion of Medicaid to people earning up to 133 percent of the federal poverty level, which is $14,856 this year.
CORRECTION: This article has been edited to say that eight governors have rejected an expansion of Medicaid in their states. A previous version said nine governors had done so.
READ ARIZONA GOV. JAN BREWER'S LETTER: