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WASHINGTON — President Barack Obama‘s health care overhaul is on track in many states, the White House asserted Wednesday. But officials said the administration is preparing a federal backstop anyway for states in which opposition to the new law has blocked planning.

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The law calls for states to build new health insurance markets called exchanges, so that millions of middle-class people who are currently uninsured can buy taxpayer-subsidized private coverage. It also expands eligibility for Medicaid so low-income adults who have no dependent children can get government insurance. Putting the two approaches together, more than 30 million Americans are expected to gain coverage starting in 2014.

But 26 states are asking the Supreme Court to overturn the health care law, and many of those have made little progress in planning their exchanges, even though the deadline clock is ticking. The law says state plans must be approved by Jan. 1, 2013 – a year in advance of the program’s launch – or the federal government will step in and run things.

“No matter where you live, on Jan. 1, 2014, an exchange will be up and running,” deputy chief of staff Nancy-Ann DeParle said on the White House blog.

An accompanying progress report said 28 states and Washington, D.C., are “on their way” toward establish exchanges, widely considered the operational linchpin of the health care law.

With a presidential election and Supreme Court decision on the fate the health care law coming first this year, 2014 seems like a long way off even if Obama‘s signature domestic accomplishment is upheld. But to federal and state officials planning for exchanges, time is short. A totally new marketplace must be created, along with systems for verifying and safeguarding confidential personal information used to determine eligibility.

Exchanges will offer consumers the same kinds of health insurance choices that members of Congress now have,” DeParle said.

But the White House report put a rosy outlook on the progress in some states.

For example, Idaho was among the states highlighted as advancing. Republican Gov. Butch Otter originally supported a state-run exchange, and his administration received a $20 million federal grant to start work. But the legislature has to approve the actual spending of the money, and Republican foes of the federal overhaul are trying to block the state from moving ahead. Faced with a standoff, Otter now says he is leaving it in the hands of the legislature.

“It seems that the White House is desperate to show progress and is selectively searching for any evidence that states are taking action,” said Mike Schrimpf, spokesman for the Republican Governors Association. “Many of the states that have started action are doing so primarily as a defensive maneuver to keep the federal government from having even greater control over their health care markets.”


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