Medical insurance markets crafted by four U.S. Republican governors won conditional approval by the Obama administration as the federal government nudges states toward full implementation of the landmark health-care overhaul.

Idaho, New Mexico, Nevada and Utah are set to meet Affordable Care Act rules for marketplaces where residents can buy insurance, the U.S. Health and Human Services Department said in a statement January 3. The agency also approved plans in Democratic-led California, Hawaii and Vermont, bringing to 18 the number of states scheduled to run exchanges on Jan. 1, 2014.

“In all of these states there’s more work to be done to be ready for open enrollment in October, but we believe they’ve made significant progress,” said Gary Cohen, director of the department’s Center for Consumer Information and Insurance Oversight, on a conference call with reporters.

The exchanges will enable consumers to compare health plans and are a linchpin of the 2010 law’s efforts to extend coverage to millions of uninsured Americans. So far, 22 Republican governors have said they’ll refuse to participate, leaving it to the federal government to set up markets in those states.

“One way or another there will be an exchange operating in every state by October 2013,” Cohen said.

Enrollment in the exchanges must begin by Oct. 1 for plans that will take effect next year. The U.S. government plans to give states that run their own exchanges a share of about $2 billion to help get them started. In addition to the 18 states, Washington, D.C., is building its own exchange.

State partnerships

As of now, the majority of the 50 states will either have to let the U.S. run the markets or choose to provide services such as consumer assistance in a partnership with the federal government. States have until Feb. 15 to enter a partnership.

Arkansas was approved to operate a State Partnership Exchange. The health agency issued additional guidelines today on how the joint exchanges will operate.

The department said it was taking no action yet on an application from Mississippi, where the Republican insurance commissioner and governor are fighting over whether to go forward with an exchange.

Cohen said the department has no deadline for granting final approvals. States that opt out of running their own exchanges will have another opportunity to apply in November, he said. If approved, they’d take over in 2015.

To contact the reporter on this story: Alex Nussbaum in New York at

To contact the editor responsible for this story: Reg Gale at

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