The final ruling for the insurance exchange portion of the Patient Protection and Affordable Care Act is out. The 644-page rule mandates that all 50 states must be ready with an exchange by October 2013. “So far, there are only about 20 states making measurable progress toward the deadline,” says Bob Laszewiski of Health Policy Strategy Associates, LLC. “Most conservative states — 29 states have Republican governors — are sitting on the sidelines waiting to see the outcome of the Supreme Court case, as well as the November elections.”

PPACA requires that states that elect to develop their own exchanges be complete and available by 2014, with the federal government stepping in to run exchanges that are not ready. Additionally, for 2014 and 2015, state exchanges will have the ability to choose whether to include businesses with 100 or fewer, or 50 or fewer, employees in their exchange — possibly leaving small businesses to fend for themselves. Not until 2016 will all employers be guaranteed the option of purchasing insurance through these exchanges.

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