By JON CAMPBELL
ALBANY -- A final state budget deal didn't include an agreement on how to set up a federally mandated health-insurance exchange, a government-run marketplace where residents can purchase medical coverage.
Now, Gov. Andrew Cuomo says he will soon take matters into his own hands.
State Senate Republicans balked an implementing an exchange that would put the state in compliance with the federal Affordable Care Act, known colloquially as Obamacare. In discussing the budget agreement Tuesday, Cuomo said he would issue an executive order "this week" that would create one.
"The Legislature has declined to include a health exchange in the budget, so we will set it up by executive order," Cuomo said.
Just how that would work remains to be seen. Cuomo didn't elaborate on what may be included in his official order, and health-care advocates said they were unsure just how much power the governor would be able to wield without legislation.
So far, 15 states have either set up or have begun setting up health-care exchanges in compliance with the federal law, though Massachusetts and Utah had theirs in place before the Affordable Care Act was passed in 2010.
Three states have created theirs through an executive order or other actions by their governor: Rhode Island, Mississippi and Indiana, according to the National Conference of State Legislators.
So far, New York has received $88 million in federal grants to set up a state-run exchange. If one isn't implemented, the federal government steps in and runs its own in the state.
Under the law, each state has to have an exchange up and running by January 2014. It has to be self-sustaining by December 2014.
Senate Majority Leader Dean Skelos, R-Nassau County, said he remains opposed to implementing an exchange, citing arguments held this week in U.S. Supreme Court on the law's constitutionality. The Senate GOP has also sponsored a bill that would spur a study of the cost of supporting an exchange, which Skelos said is unknown.
"We have no idea if you enroll a million more people or whatever into the Medicaid, what is it going to cost us?" Skelos told reporters Wednesday. "I think it's legitimate to have certain questions answered, but nobody wants to answer those."
But Skelos said his conference wouldn't challenge Cuomo if he enacts one on his own, without legislation.
"The governor has the right to issue executive orders," he said. "If someone wants to sue him, fine. But I do believe he has the right to issue an executive order."
Blair Horner, vice president for advocacy for the American Cancer Society of New York and New Jersey, said his group was pleased to see Cuomo pledge to force the exchange forward, and will be watching closely to see what is included when the executive order is released.
"The devil, of course, is in the details," Horner said. "But we applaud for the governor for taking the next step, and we're disappointed that the Senate blocked what really should happen, which is to set up a statute."
Senate Insurance Chairman James Seward, R-Milford, Otsego County, said he would "monitor (Cuomo's) executive order and what may come of that."
"We'll see down the road what more action may be needed," Seward said. "For the moment, the federal legislation is in limbo with the Supreme Court considering the constitutionality questions and we continue to have questions about the costs."
Assemblyman Kevin Cahill, D-Kingston, Ulster County, said the court's pending decision shouldn't have an impact on the state-level health exchange debate.
"What's going on in the Supreme Court (this week) is a distraction from what are our duties," Cahill said. "If the court rules a different way, then we should come back to it. But for now, we should go forward with our obligations."
By Jon Campbell