The PPACA calls for each state to set up a health care "exchange"—a government-run marketplace where people can purchase subsidized, regulated health insurance (as Philip Klein said, "government-designed policies from a government store"). Health and Human Services secretary Kathleen Sebelius has started to work with state governors, but it looks like the process won't be easy:
Ms. Seblius's efforts come as some states prepare for friction with her department over the early provisions in the law, since they say they are underprepared to implement many aspects of it.
Missouri will hold a ballot on Tuesday on whether to knock down the health-care law by invalidating the requirement that most people buy insurance or pay a fine. Some other states are planning similar votes.
Early this month, Ms. Sebelius's office plans to host governors' staff from across the country to begin tackling the most ambitious part of the legislation, which calls for setting up state-based exchanges where some 30 million Americans are expected to buy coverage.
State officials say they are struggling to meet the law's deadline for getting the exchanges running by 2014. Strapped budgets have left states without the staff to handle basics such as writing grants to apply for implementation funding, officials say.
"I am very sensitive having been in that situation myself," Ms. Sebelius said. "It really helps to have been a governor."
Some governors say her department is underestimating the law's burden on states.
"The bill raises almost 1,000 questions and so far they have zero answers," said Indiana Gov. Mitch Daniels. "This is going to be a nightmare, and you would think her gubernatorial experience would have given her a good intuition for that."
And, the article notes, even Democratic aides are worried that building the exchanges is going to put significant new burdens on state governments.
One point that I think didn't get made enough prior to the passage of the law was that, due to its phenomenal complexity, the implementation process, much of which happens within state governments, was bound to be a mess. And it was likely to ask states to expend resources they weren't likely to have. We've already seen this with the high-risk pools, which were intended to bridge the gap between passage and total implementation in 2014. But the law only provided enough money to run the program through 2011 or 2012.