In spite of the fast approaching January 1, 2013 deadline of submitting State Health Insurance Exchange (HIX) plans, most states seem reluctant to invest majorly in setting up functional insurance exchanges – the web based marketplaces for selling subsidized health plans to millions of uninsured Americans.

Most states, lagging behind in their health exchange plans, are either waiting for the Supreme Court’s final ruling on ACA or the results of the next U.S. elections scheduled to be held in November. The Supreme Court ruling which will be declared in mid-summer 2012, will decide if the Affordable Care Act and its Individual Mandate clause is in line with the federal constitutional guidelines. If either or both of them are found to violate any constitutional guidelines, the individual mandate clause or the entire ACA may get repealed.

Each of these state based exchanges will have a website where the consumers can come and purchase health plans. Information Technology will play the primary role in setting up these health insurance exchanges. Several states are struggling with the technical processes that will be necessary for setting up operational health exchanges - plan eligibility verification, consumer enrollment, subsidy calculations, integration and interconnection between existing and new healthcare IT entities.

The government has already dispensed with $600 million as grants to U.S. states to help them establish their exchanges, but the states will need to find out ways to tackle the operational costs. Several states that are already struggling with their fiscal challenges are reluctant to spend on setting up exchanges.

The Urban Institute team found in a nationwide study that only 14 U.S. states have made any considerable progress in setting up exchanges, 20 states have made some progress but the rest 16 states are still biding for time.

Some U.S. states such as California, New Jersey, Oregon, Washington, Rhode Island, Maryland, Vermont and Connecticut are aggressively charging ahead with their insurance exchange establishment plans. Last year, Connecticut set up a health insurance exchange for small businesses.

Ironically, the states that are lagging behind in their health exchange plans are the very states that are most in need of such online marketplaces to boost their health insurance market.

In some states, New Hampshire for example, although the governor showed interest in setting up an insurance exchange, the state legislatures were not quite taken in with the idea and returned the $666,000 grant back to the federal government.

Other states, such as Michigan, Ohio and Iowa, are waiting for their health insurance exchange bill to pass their state legislature. Oklahoma is still weighing its options in setting up a non-compliant exchange.

States like Alabama and Florida that feature among the 26 states that filed law suits against the ACA, are waiting for Supreme Court’s ruling before they begin any work on their health insurance exchanges.

In another 10 months the states will need to submit their health insurance exchange plans to the government failing which, the federal government will step in to establish their own exchanges – an option which most U.S. states may not be agreeable to.