The health law's biggest changes don't take effect until 2014, when states and insurers must be ready to begin signing up an estimated 32 million people in Medicaid and private insurance. But a successful rollout in two years hinges on critical decisions that states must make – and take quick action on – this year.
It will be difficult for many states to meet fast-approaching deadlines, and some may not make it, says Brett Graham, a managing director at Leavitt Partners, a consulting firm working with states on implementation of the law.
Time is short, and states are missing key pieces of how-to guidance from the federal government about everything from what various insurance exchange options will look like to which benefits must be included in health plans, he says. To make matters worse, states are competing for a limited pool of information technology vendors to help them get started.
"It's a pressure cooker," said Graham. States are "in a position where they have to act with imperfect information."
One of the most pressing tasks for states this year has to do with the creation of exchanges, through which individuals and small businesses can buy insurance starting in 2014.
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