As deadlines pass for states to tell the federal government their plans for implementing the Affordable Care Act (known as Obamacare), questions remain about how the law will eventually look in North Carolina.

In the wake of the election, the most immediate question was what choice the state would make for running a health benefits exchangean online marketplace where state residents can shop for insurance options.

Last Thursday, Gov. Bev Perdue announced North Carolina would participate in a state-federal hybrid exchange because the state is not ready to run its own. Federal planners will create and run the exchange, and state officials will run the consumer support portion of the program.

Many state legislators had said they preferred North Carolina not cede control of the exchange to the federal government. During the 2011 session, the N.C. House passed a bill expressing that intent, but the bill did not make it through the state Senate. And, in the end, the General Assembly never authorized a North Carolina exchange.

The Affordable Care Act calls for the creation of exchanges in all states by Jan. 1, 2014. All legal U.S. residents are eligible to purchase insurance through the exchanges but low-income people and households could benefit in particular, because they will be able to receive tax credits, a form of federal subsidies, to buy insurance through the exchange.

An independent consultant estimated about 700,000 North Carolinians would likely buy their insurance through the exchangemany of them previously uninsured.

So organization automatically reverts to the federal government for now, but that can change, according to Pam Silberman, head of the North Carolina Institute of Medicine. She said states that delayed their decision can plan for their own exchanges to kick in in 2015 or later.

“Speaking for myself personally, I would hope that the governor would make the indication to the federal government of the state’s intent to pursue a state health benefit exchange,” state Rep. Nelson Dollar, R-Cary, told the legislative health and human services oversight committee last week before the governor’s announcement. Dollar co-chairs the committee.

Dollar said that he believed the decision was in Perdue’s hands. But other Republicans lawmakers said Perdue’s hands were probably tied because the Legislature delayed acting while it waited for the outcome of the Supreme Court decision this summer and the presidential election earlier this month.

“Now we’re in a situation where this is established law,” said state Sen. Ralph Hise, R-Spruce Pine, who said he was frustrated the state was left with little choice but to allow the federal government to run the exchange.

Nonetheless, when Perdue made her announcement, she came under criticism by Senate leader Phil Berger, R-Rockingham, who said Perdue should have left the decision to incoming governor Pat McCrory.

Later, McCrory said he was pleased Perdue’s decision kept the state’s options open for changes in the future.

A spokeswoman from the state Department of Insurance said details are still being worked out on how the hybrid exchange will look. North Carolina’s application includes a request for $74 million in federal funding to launch the plan’s management, hire more consumer assistance staff and improve technology to communicate with the federal exchange.

Silberman said the state Department of Insurance already has robust consumer support and ombudsman programs, and it would be possible to beef those up to support consumers who will buy insurance through the exchange.

In guidance given to states last week, U.S. Secretary of Health and Human Services Kathleen Sebelius said that for states planning partnership exchanges, her department would accept details about the partnerships until mid-February.

Hoban is founder of, a local nonprofit news site dedicated to health care coverage, where this story first appeared.

This article appeared in print with the headline “Governor M.D.”