Even with the constitutionality of the federal Affordable Care Act in doubt, many states are positioning themselves to be ready to comply with a key provision of the federal law: insurance exchanges.

Maine is not one of them.

Maine is among many states deferring action until the U.S. Supreme Court rules on constitutional challenges to the law. Those states could be holding out to their own detriment. They risk losing local control of how their exchanges would be run and having the federal government impose its own version on them.

The exchanges — competitive marketplaces that allow consumers to shop for and purchase health care — are required under the Affordable Care Act. They are supposed to be operational by January, so they must be established well before that.

A March study by the Kaiser Family Foundation found that only 13 states had set up exchanges and three others had firm plans to establish one. Others were either studying options or simply waiting. These states are in danger of falling behind, the study said.

“The deadline to demonstrate an operational exchange is fast approaching, and even those states moving more aggressively may find it difficult to put all the pieces into place in time to meet it,” the report concluded.

A recent collaborative known as Enroll UX2014 was launched this week to help states establish exchanges. The initiative offers a template of sorts that allows states to retain control of their own exchanges without the need to invent the wheel on every detail.

The public/private initiative was organized in early 2011 by the California Health Foundation and is backed financially by a group of nonprofits that support the health reform law. States involved in this collaborative run the gamut from reliably Democratic, such as New York and Washington, to traditionally Republican, such as Alabama and Kansas.

Maine is not involved in the collaborative, and it’s not clear whether it will take advantage of the group’s work.

The state is one of many that doesn’t have a health insurance exchange, even in skeletal form.

In one of the more partisan battles of the recent legislative session, State House Republicans deferred setting up an exchange. Instead, they passed a bill to create a network of licensed “navigators” — experts in the health insurance industry — to help Mainers traverse the tricky insurance world.

But that bill only goes into effect if the Affordable Care Act is upheld. The Supreme Court is expected to issue a ruling later this month on constitutional challenges to the law made by 26 states, including Maine and most other states controlled by Republican governors and legislatures.

Rep. Joyce Fitzpatrick, R-Houlton, a member of the Legislature’s Insurance and Financial Services Committee, called the GOP-backed bill a preventative measure.

“It protects us a little bit if the government sets up an exchange because it allows us to use approved navigators,” she said.

Doug Dunbar, a spokesman for the state’s Bureau of Insurance, said the bureau is in the process of implementing the new law, but he didn’t have an update on the status.

Rep. Sharon Treat of Hallowell, the lead Democrat on the insurance committee, said she has been frustrated with Maine’s failure to implement parts of the health care law. If it is upheld, she said, Maine will not have enough time to set up such a complicated system.

The Kaiser study agreed. “States that elect to wait until after June 2012 to begin exchange planning may find there are few legislative options remaining given the short timeline,” the report said.

States that don’t set up exchanges at all will turn over control to the federal government. Treat said that would be bad for Maine.

“Even the (Maine) chamber of commerce has called it a missed opportunity that we didn’t set up an exchange,” she said.

Fitzpatrick isn’t so sure. “As far as we were concerned, the feds were going to make (states) all play by the same rules, so there wasn’t a big benefit to doing our own thing,” she said.

Staff Writer Eric Russell can be contacted at 791-6344 or at: [email protected]

Twitter: @PPHEricRussell