The Obama administration recently issued a deluge of regulations on various provisions of the Affordable Care Act (ACA), but states say they still have a lot of questions about the guidance that’s come out, particularly as it applies to building the health insurance exchanges that are critical to getting more individuals and small businesses enrolled in coverage.

The Department of Health and Human Services (HHS) on November 30 issued a 373-page regulation that addresses cost-sharing limits and user fees that would be paid by insurance companies that participate in the federal exchanges. HHS has also recently issued regulations that keep insurance companies from discriminating against people with preexisting conditions; outline policies and standards for coverage of essential health benefits; and implement and expand employment-based wellness programs to promote health and help control healthcare spending.

Associations are watching these developments closely, both as employers that will be required to comply with ACA regulations and as potential “navigators” in educating the public about the exchanges.

Members of the National Association of Insurance Commissioners, in Washington earlier this month for a meeting, told Politico that they’re still frustrated and looking for more clarity from the administration, particularly when it comes to technical details about federal exchanges.

“We’re still very much depending on getting further guidance from HHS. There are still some major gaps,” said Washington State Insurance Commissioner Mike Kreidler, whose state is setting up its own health exchange. “The timetable that we have is going to be a real challenge. … We’re still plowing ahead, but without some of this critical guidance from the federal government, it’s going to be very difficult.”

Exchanges, which will be the marketplace for millions of individuals and small businesses to shop for health coverage, are required to be operational in every state by January 1, 2014. Initially, states had a November deadline for telling HHS whether they would operate their own exchange, but the date for submitting a detailed blueprint for their exchange was pushed back to December 14. Many states delayed work on the exchanges to see whether the Supreme Court would overturn the law last summer and whether GOP nominee Mitt Romney, who promised to repeal the ACA, would be elected president.

Neither of those things happened. Now it’s been projected that many states that want to operate their own exchanges will not be able to get them up and running by 2014, and that the federal government may have to create exchanges for 30 or more states in the first year of operation. Despite the deadline extension, HHS still plans to grant full or conditional approval of state plans by January 1 and still expects the exchanges to be operational by 2014.

(iStockphoto/Thinkstock)