Time's up.

Today's the deadline for state lawmakers to decide if they are going to set up their own health insurance exchange, partner with the federal government, or let the feds come in and run the whole thing.

As of Tuesday, HHS had conditionally approved 18 state exchanges (including the District of Columbia) and three state-federal partnerships. In fact, my governor, Pat Quinn, got an early valentine from HHS Secretary Kathleen Sebelius when she showed up at a clinic on Chicago's West Side Tuesday to announce conditional approval of the state-fed partnership.

The so-called insurance marketplaces need to be up and running by October so consumers can begin enrolling in insurance plans by January 2014.

A slim majority of Americans believe that setting up an exchange should be a "top priority" for their governor and legislature, according a survey released late last month by the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health. Among other things, the poll found that:

  • 55 percent of respondents said creating an exchange should be a top priority.
  • 52 percent of respondents want their state to expand Medicaid (the numbers skew along more traditional party lines when broken out by Democrat, Republican and Independent).

Regarding the current budget debate, respondents want no or limited reductions to governmental health programs:

  • 58 percent don't want Medicare cut at all; 31 percent were willing to accept minor reductions.
  • 46 percent don't want cuts to Medicaid while 37 percent favored minor reductions.
  • 75 percent said the budget crisis can be addressed without cuts to Medicare.

You can find the complete survey here.

Now, back to watching the clock to see if there's a mad dash for governors to get their "declaration letters" into HHS.