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Health care questions dog states

The election might have settled the debate over repeal of the federal health care act, but it probably created more questions for Hoosiers. Where does the state stand, given that its leaders are unanimous in their opposition?

Here’s a look at some of the biggest questions:

What options do states have?

They can set up their own health insurance exchanges – an online marketplace for individuals and small businesses to shop for the best coverage, with assistance from the government in paying premiums. They can also join a program run by the federal government or allow the federal government to set up their state program.

When is a decision due?

States were supposed to make a decision on a state exchange and submit a framework for establishing one by Nov. 16. But the deadline is extended now to Dec. 14. States have until Feb. 15 to decide on participating in a federal exchange.

What will Indiana do?

Gov.-elect Mike Pence, a staunch opponent of the Patient Protection and Affordable Care Act as a congressman, has rejected both the state-based exchange and a federal partnership.

“It is estimated that establishing a state-based exchange under the regulations developed by the U.S. Department of Health and Human Services will cost taxpayers in our state approximately $50 million per year,” Pence wrote in a letter to Gov. Mitch Daniels last week. “Despite this investment, there is no evidence that such an exchange would benefit Hoosiers, give us significantly more control over our healthcare choices or lower the cost of insurance premiums.”

What are other states doing?

Seventeen states have opted for their own exchanges, with at least three more expected to choose that option. The governors of Ohio, Michigan and Florida have said they won’t set up a state exchange but will work with the federal government. Missouri Gov. Jeremiah Nixon, a Democrat, rejected the state plan and is leaving the decision on a federal partnership to the state legislature. Wisconsin Gov. Scott Walker and Georgia Gov. Nathan Deal have joined Pence in rejecting all of the options.

What about Medicaid expansion to cover the uninsured?

The U.S. Supreme Court ruling leaves that option to the states, with the decision not yet due but Indiana’s Republican leaders opposed. In September, a health reform consultant told state officials that expanding Medicaid eligibility to meet the federal guidelines would cost the state $200 million a year from 2014 to 2017, but the amount could be covered using cigarette tax reserves and revenue, along with the annual savings from eliminating the state’s high-risk insurance pool. The latter is no longer needed because the Affordable Care Act covers pre-existing conditions. Thirteen percent of Hoosiers are uninsured, according to figures from the Kaiser Family Foundation.

“With the federal government picking up the vast majority of the cost of the expansion, there’s little downside in the short-term for states that accept the policy,” writes Aaron Carroll, vice chair for health policy and outcomes research at Indiana University School of Medicine, for an online news service of the Journal of the American Medical Association. “There’s also a ton of upside – millions of people receiving insurance who previously lacked it. I still maintain that it will be difficult for governors to tell their constituents that they are refusing the federal government’s offer and leaving people uninsured for a political principle.”