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States Control Your Health Care Fate

Kathy Kudner, a partner who specializes in health care at the national law firm Dykema, also said she believed that premiums are "going to vary significantly" from state-to-state.

Kudner also said she expects there will be some exchanges that are ready to start enrolling people and businesses as of the Oct. 1 target date, and that there will be some marketplaces that may not be ready to go—creating more uncertainty among purchasers of insurance.

"I think the federal exchanges will be ready, and I think there are a number of states that will be ready, but I think there are a number of states that have not done much at all," Kudner said.

But even if all of the federal marketplaces are up and running, the offerings from those exchanges to consumers will not necessarily be consistent state-to-state.

Kudner said that hypothetically speaking, one state whose marketplace is being run by the federal government could offer 55 different insurance plans for consumers to pick from, while another state could offer just a handful—dramatically limiting choices in benefits and costs. That's because there's no guarantee that all insurers eligible to sell insurance in a state will elect to participate in the marketplace there, or that they will be selected to do so by the administrators of that exchange.

An extreme example of the uncertainty about coverage options faced by consumers is being seen in Mississippi, where the federal government will run the insurance marketplace.

In Mississippi, no insurer has stepped forward to offer coverage options to people in 36 counties out of state's 82 counties—meaning that about 54,000 people could be left unable to buy insurance on the marketplace there. The federal government has granted an extension of the time insurers have to submit proposals in response to that situation.

To direct people to the marketplaces, the federal government has set up the online portal

"It seems pretty user-friendly, Kudner said.

In addition to that, Kudner noted, "the law requires the exchanges to have what are referred to as navigators"—people trained in guiding consumers through the marketplaces.

She said she expects there to be variation between how well navigators in different states do their jobs, and "that's going to be a big factor in how easy it is" for consumers to enroll in the exchanges and make wise choices.

The number of people who enroll in a given state could significantly effect how well the marketplaces achieve their stated goal—providing affordable health insurance to those currently without insurance.

If not enough people sign up—particularly enough healthy people who are less likely to use a plan's benefits—insurers could raise their premiums to cover their costs.

"The idea is that you'll be pooled with everyone on the exchange," Kudner said, "And competition will lower cost."

Krishnan, the CEO, said he believes that in the long run, the marketplaces will achieve that goal after working through their respective kinks.

"Fundamentally, I'm very bullish on it," Krishnan said.

—By CNBC's Dan Mangan. Follow him on Twitter at @_DanMangan.

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