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Published by Jeffrey Young
New Jersey Gov. Chris Christie (R) became the latest state chief executive to rebuff President Barack Obama's health care reform law Thursday by vetoing a bill that would have created an online marketplace for uninsured residents to shop for health insurance.
New Jersey Gov. Chris Christie (R) became the latest state chief executive to rebuff President Barack Obama's health care reform law Thursday by vetoing a bill that would have created an online marketplace for uninsured residents to shop for health insurance.

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Published by: Jeffrey Young on Dec 06, 2012
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December 6, 2012
SENATE BILL NO. 2135(First Reprint)
To the Senate:Pursuant to the Patient Protection and Affordable Care Act, a“health insurance exchange” must be established in each state eitherby the government of that state or by the federal government. To carryout this provision, the “Affordable Care Act” allows states the choicebetween three Health Insurance Exchange options: a “State-basedExchange”; a “Partnership Exchange”; or a “Federally FacilitatedExchange.” Any state that does not select a State-based Exchange orPartnership Exchange, or does not inform the federal government of aselection, will be placed into a Federally Facilitated Exchange.Senate Bill No. 2135, passed by the Legislature on October 18 ofthis year, seeks to establish a State-based Exchange in New Jersey.While I appreciate the Legislature’s attempt to craft a bill toimplement this portion of the “Affordable Care Act,” I cannot agreethat this codification of a State-based Exchange is the mostresponsible selection for New Jersey. The federal government hasdirected states to decide whether to establish a State-based Exchangefor calendar year 2014 by December 14, 2012, just over a week fromnow, but New Jersey and all other states still await substantialfederal guidance on the functioning of all three types of Exchanges.To be sure, the decision of whether to move forward with a State-basedExchange can only be fully understood when competitively compared tothe overall value of the other options.For example, while we know that both a Federally FacilitatedExchange and a Partnership Exchange would be financed through “userfees” paid by insurers, only late last week did the federal governmentfinally offer a preliminary glimpse as to what those costs mightinclude. And this latest proposal which is neither final norcomprehensive — raises more questions than it answers. For example,further clarification is still needed on whether the federalgovernment intends to share user-fee revenue with the states in aPartnership Exchange.
Moreover, New Jersey still requires guidance on the operation ofa Federally Facilitated Exchange. The federal government has yet topresent a structured blueprint for the design and operation of aFederally Facilitated Exchange and the technical details for itslinkage to each state. This uncertainty regarding the potentialoperation of Partnership Exchanges and Federally Facilitated Exchangesnecessarily clouds the analysis of whether a State-based Exchangewould be the best option of the three for New Jersey.Lastly, financing the building and implementation of a State-based Exchange would be an extraordinarily costly endeavor. Asdrafted, Senate Bill No. 2135 would create an expensive newbureaucracy. While the federal government has enabled states to applyfor grant funding to cover some of the initial costs of such anendeavor, the total price for such a program has never beenquantified, and is likely to be onerous. Without knowing the fullscope of which Exchange option would be most beneficial and costefficient for New Jerseyans, it would be irresponsible to force such abill on our citizens.In addition to those and other known questions, the last severalweeks have triggered an apparent restart of proposed federalregulations relating to the “Affordable Care Act,” and new guidancecontinues to trickle out of Washington at an erratic pace. Whileadditional federal direction is welcome, there is no clear indicationnow of what new rules and guidance will be released, or when thatcrucial information will be provided. States deserve a predictableplan for future federal rulemaking on the “Affordable Care Act.”Without clear answers to basic questions, it would be imprudent forNew Jersey to implement a State-based Exchange at this time.My decision today should not be interpreted as foreclosing futureconsideration on this matter. In fact, the federal government hasprovided states with the flexibility to amend their Exchange selectionin subsequent years. Moving forward, I welcome further guidance fromthe federal government so that New Jersey can make a fully informed

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