This new statute is aimed at insuring those who have previously been uninsured, eliminating some of the Draconian limitations, such as pre-existing condition exclusion, of private insurers, requiring more coverage for various diagnostic procedures and mental health, maintaining children under the age of 26 on parents' coverage, and reducing health care costs for everyone, including the federal and state governments.
The goal of ensuring those who are presently uninsured is meant to be implemented in four ways, through an expansion of Medicare coverage; through the creation of "exchanges" which will provide individuals the ability to purchase their own hopefully affordable health insurance; through incentives and disincentives to businesses; and through incentives and disincentives for individuals, assistance from the federal government in paying for insurance and a tax on those who do not.
State governments have the choice of accepting federal aid to expand their Medicare rolls, with the federal government picking up the entire cost of this expansion for a few years and then a commitment to pick up 90% of the cost thereafter. Some states have chosen to accept this offer, while others have not. State governments also have the choice of setting up their own exchanges to offer health insurance to individuals. Some are doing so, and others are not. For those states that do not do so, the federal government exchanges will be available to individuals.
At the local level, for states that have chosen to expand their Medicare coverage, the administration of this program is usually accomplished at the county level. As far as the exchanges are concerned, it is not clear to me whether these will be administered at the county level.
So, there is a role at all levels of government for this new statute. How large a part state and local government will play is unclear, depending largely upon whether or not a state opts in to the Medicaid expansion and the exchange creation.