Guam - For the first time in more than a handful of years, Government of Guam workers and retirees were given the option of choice when it came to selecting their health insurance. And while that open enrollment period just ended over the weekend, another major concern over healthcare looms over the island as to how to fulfill federal mandates in which Guam cannot afford.

Committee on Health chair Senator Dennis Rodriguez Jr. says the Patient Protection and Affordable Care Act (otherwise known as Obamacare) is a rather complex initiative and how it applies to Guam is even more so.

A major component of the program that has raised concern within island leaders is the health insurance exchange. "It's like a one-stop marketplace where people can go and select their health insurance coverage," he said. "It's supposed to be where different insurance plans are put in and anyone would be able to go in there and purchase health insurance coverage."

Rodriguez says the concern over the exchange isn't anything new and has actually been discussed in the past two years. "So the problem is that we don't have the federal subsidies that comes with establishing an exchange like the mainland United States does, and that's very unfortunate for Guam and the territories," he said.

In fact, the island was given a one-million dollar grant to do a study on the exchange, but there were concerns as to whether if Guam did not set up the exchange, would it have to return the money. And in his weekly address, Governor Eddie Calvo shared the same concern saying none of the territories are given options on how to fund this program. "This means the federal government would force Guam to find the money on our own, money they know very well we can't afford. It will cost more than $100 million just to stand up the Insurance Exchange," he said. "GovGuam will be forced to pay $74 million every year to keep the program going."

Governor Calvo further states it's another example of the feds treating Guam and all the other territories like second-class citizens, noting, "I'm very disappointed, because ObamaCare is supposed to help the 30,000 Guamanians without insurance - and it doesn't. Once again, the federal government leaves us no choice but to figure it out on our own."

Rodriguez meanwhile says the clear intent of Obamacare is to get access to healthcare for all Americans and while Guam and the territories were obviously left behind, it's now about taking proactive measures. It was back in August when Governor Calvo announced an initiative aimed at helping 30,000 Guamanians who do not have health insurance.

"We just met with the governor's key individuals in his administrations so they're working out a plan to ensure they have this working group put together as soon as possible," he said,.

Among the ideas include expanding Medicaid to include more people, changing the law and requiring everyone to have health insurance similar to Obamacare and implementing an incentive program that would allow small businesses that can't afford health insurance for their employees and allows them to band together as coops.

Tax commissioner Art Illagan meanwhile tells KUAM that the problem is rooted at how the territories are treated differently. He adds while the concern has been raised to the federal government, the response has simply been "this is the law." He further states the commissioners of the territories including American Samoa, the CNMI and the Virgin Islands have written letters to Health and Human Services asking how to resolve this issue. He ultimately says if the territories' request to delay until the resources are found is denied, "most likely the people who have insurance will have to bear the burden for people who don't have insurance and rates will go up."

October 1st meanwhile is the start of when the exchange is supposed to be operational nationwide with all the major components of Obamacare set to start at the beginning of next year.