Iowans might find themselves without a state-designed health insurance exchange by 2014, but that’s not going to happen in Illinois.

The health insurance exchange is a key aspect of the 2010 Affordable Care Act. It is envisioned as an online and real-time marketplace in which consumers can buy health insurance. Illinois officials are reviewing five bids from Internet companies, one of which will build the system in their state.

Iowa Gov. Terry Branstad, on the other hand, continues to wait for the plan from a working group he appointed

20 months ago and has yet to decide on jurisdiction for the state’s exchange.

States are to issue a letter by Friday to the U.S. Department of Health and Human Services saying whether they will design their own health insurance exchange.

The federal department has extended exchange deadlines, secretary Kathleen Sebelius announced last week. The letter of intent is due Friday, but the actual plan, or blueprint, for the exchange may be submitted by Dec. 14. If a state does not offer a plan, the Affordable Care Act, requires the federal government to set up the exchange.

Iowa’s working group was chosen by Branstad shortly after he took office in 2011. It is to plan the exchange and bring back a report to the executive branch.

“That group is working to meet the Nov. 16 deadline,” Tim Albrecht, the governor’s spokesman, said in an e-mail message. “Ultimately, the governor will use the information to make a decision on the exchange.”

Albrecht said Iowa, like some other states, will be challenged to meet the deadline.

Insurers, hospitals promote

Federal law requires that by January 2014, each state introduce a working exchange for people to buy health insurance. The exchange will be for those individuals who do not get their health coverage via their employers, for instance.

It is designed to be offered online to all residents and also in a more traditional setting. Illinois, for example, intends to set up a call center for residents who do not have access to the Internet.

An exchange is to offer residents an affordable choice of plans and with various degrees of benefit coverage. Consumer assistance is to be included.

Health insurers are working with the state government to design the exchanges, including Wellmark Blue Cross Blue Shield, one of the largest providers in Iowa.

“Wellmark has continued to remain engaged in conversations with policymakers as Gov. Branstad and his administration determines the best health insurance exchange approach for the state, said Traci McBee, spokeswoman for the firm. “We have long supported a state-based health insurance exchange but need to see the final rules and regulations before we finalize our plans to participate.”

Local hospitals, in the meantime, continue to provide care for those with and without insurance, but they look for a change in two years.

“I am pleased that Illinois is moving forward with the establishment of the insurance exchange, and I hope Iowa will decide to move ahead as well,” said Rick Seidler, president and chief executive of Trinity Regional Health System.

“The exchange is a key aspect of the Accountable Care Act, and there is potential to reduce the contribution that hospitals and other providers make to their communities by providing care regardless of people’s insurance status or ability to pay,” Seidler added.

The success of the exchange in all states will be driven by the ability and willingness of insurers to provide competitively priced individual insurance options to the exchanges, he said.

Political football

Iowa is among more than half the states that have not decided the exchange design. The effects of the Nov. 6 election still unfolding, but it remains a law that many Democrats support and many Republicans do not.

One of the lead supporters in Iowa is Sen. Jack Hatch, D-Des Moines, co-chairman of the Iowa Legislature’s Health and Human Services Appropriation Committee. Hatch is the Senate Democrats’ leading expert on the legislation.

Hatch has accused the governor with political posturing on the issue and said he will host a news conference Tuesday in Des Moines.

“I will call for a bipartisan working group to be formed of legislators, representatives and leaders of the relevant committees and will invite the governor and members of the executive branch to participate,” Hatch said.

Calling the governor’s current working group too partisan, Hatch said a new group will better positioned to shepherd health reform through the legislative process.

“Their opposition was based on politics,” he said of Republicans. “We are committed to a bipartisan narrative. I hope we get a new start in this.”

Albrecht, the governor’s spokesman, said that although the governor believes in an Iowa-designed exchange, he said the federal government has not clearly outlined what is expected with an exchange.

“We await word on any constraints that may hinder states in their efforts to construct a state-specific exchange,” he said.

Iowa and Illinois have accepted federal money to set up the exchanges: In Illinois, it is $38,989.615; in Iowa, it is $35,376,665, according to Kaiser Health News.

Illinois situation

Illinois is among 15 states that are moving ahead with exchanges. It is estimated that 800,000 uninsured Illinois residents will have coverage in 2014 because of the law. That figure would have beaten the 1 million mark by 2020, if no changes had been made.

The Illinois Department of Insurance has received proposals on the exchange contract from Infosys, CGI, Deloitte Consulting, Xerox and Cognizant Technologies Solutions. The contract requires that the work be done in the United States.

The company that wins the bid would be required to design and build a website with “no wrong door” for consumers — a user-friendly site that would seamlessly guide them to Medicaid, the children’s health insurance program or private insurance, depending on each consumer’s eligibility. The exchange would need to share data with Illinois’ Medicaid agency. Consumers would be able to find out whether they’re eligible for new federal subsidies to help pay premiums or whether they qualify for Medicaid.

“It’s a fairly daunting challenge, quite honestly,” said Brian Patt, who is with Infosys Public Services of Reston, Va., one of the firms bidding on the state contract.

Illinois would take over full management of its exchange in 2015, the second year of the national health law’s full implementation.

In the first year, Illinois plans to partner with the federal government, said Colleen Burns of the Illinois Department of Insurance. If the state’s plan is approved, the federal government would run the website and a call center. The state would decide which insurance plans qualify to be sold on the exchange and provide in-person consumer assistance.

“Our intent is to partner with the federal government for the first year. Once the legislation has passed, we can bridge to a full state-based exchange in 2015,” Burns said.

(The Associated Press contributed to this report.)