“As a former governor, I trust you know the challenges states face when trying to navigate the murky waters of implementing a federal mandate without clear guidance,” he wrote in a Nov. 16 letter  intended to meet a now-extended deadline for states to decide whether to build their own insurance markets. “We continue to struggle with too many unanswered questions on topics critically important to the final development of an exchange that meets the needs of Iowans, including the cost of building and operating an exchange.”

Branstad and New Jersey Gov. , also a Republican, are more public than some other state leaders in their criticism of  the health law, but they are not the only ones demanding answers on how the exchanges must be set up. A National Association of Insurance Commissioners committee is compiling a about exchange regulations, which had 40 questions as of Monday afternoon. The nonpartisan group said it will also post answers as the questions are answered by the administration.

Exchanges are websites where individuals and small businesses will be able to shop for coverage and find out if they are eligible for federal subsidies or Medicaid beginning in 2014. Under the law, the federal government must set them up in states that don’t build them.  As of Friday, 18 states and the District of Columbia had indicated they planned to go ahead with state-based markets.

States have until mid-December to inform federal regulators if they will build their own markets and until mid-February to say if they want to partner with the federal government.

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