HARRISBURG, Pa. -- A state-run health insurance exchange is unlikely to be ready for a scheduled January 2014 rollout, Pennsylvania's top insurance regulator said Wednesday.
Insurance Commissioner Michael Consedine said development of the online exchange _ a key element of the federal Affordable Care Act _ has stalled because too many questions about its cost and other operational details remain unanswered by the federal government.
"We want to make smart, informed decisions for Pennsylvanians," he said "We're not going to rush headlong into this and make poor choices."
Besides running their own exchanges, states have options that include jointly running exchanges with the federal government. If Pennsylvania does not choose one of those options, the federal government will operate an exchange in the state starting in 2014.
There is no penalty for launching a state exchange later on, Consedine said. "We certainly think a wait-and-see approach has some advantages."
Advocates for uninsured and under-insured people had hoped for a state exchange tailored to Pennsylvanians' needs, but said a federal exchange would be satisfactory so long as it provides high-quality insurance.
Antoinette Kraus, director of the Harrisburg-based nonprofit Pennsylvania Health Access Network, said the federal law is designed to give states flexibility in designing their exchanges _ a point also made by the U.S. Department of Health and Human Services.
"We will work with any state to set up an exchange at any time," HHS spokesman Fabien Levy said.
A 2011 study by a state Insurance Department consultant conservatively estimated that at least 2 million Pennsylvanians would use the online exchange to shop for and buy individual health insurance policies.
The state Insurance Department held a series of public hearings on a state exchange and hired consultants to analyze the marketplace, but is unlikely to meet a Nov. 16 deadline for submitting a blueprint to HHS.
"We went pretty far down the line," but still lacked definitive guidance, Consedine said. "At this point it's going to be extremely difficult" to get a state exchange up and running in the next year.
Although the 2010 health care reform law advocated by President Barack Obama was upheld by the U.S. Supreme Court in June, it remains a lightning rod in the presidential election campaign with Republican nominee Mitt Romney vowing to repeal it if elected.
In July, the Republican Governors Association sent a letter to the Democratic president asking for more information about the exchanges and a prospective expansion of state Medicaid spending.
Consedine has written to HHS Secretary Kathleen Sebelius and testified before the U.S. House Ways and Means Committee, seeking answers to a laundry list of questions about the exchanges.
Consedine was appointed by Gov. Tom Corbett, a Republican who as state attorney general joined his counterparts in other states in an unsuccessful court challenge to the law.
Kraus said that may explain why Consedine is moving slowly on the state exchange.
"I think some of it has to do with politics," she said.
Consedine acknowledged that Romney's repeal threat " adds another level of uncertainty" about the law, but said he and his fellow state insurance commissioners are more concerned about obstacles to implementing it.
"We're regulators ... most of us are appointed. We're not elected. We're just trying, by and large, to do the right thing for the people of our state," he said.