by Mindy Aguon

Guam - Earlier this week, Governor Eddie Calvo rejected the option of establishing a health insurance exchange on Guam as part of the ever-controversial Patient Protection and Affordable Care Act, otherwise known as Obamacare.

There's been no shortage of debate on Obamacare across the nation and it's no different here at home. Specifically, the health insurance exchange component has raised concern with islands leaders on how Guam, along with the other territories, is treated differently.

"On October 1, Governor Calvo submitted a letter to (Health and Human Services) Secretary (Kathleen) Sebelius and what he had mentioned was that we are not going to establish an exchange," explained Brian San Nicolas, the governor's special assistant for healthcare. He says unlike the states who would receive subsidies to establish the exchange and are covered by the federal government, Guam would not - simply put - it's another unfunded mandate.

"So just to get our exchange going for the first year, would require advance premium tax credits, the subsidy to get people the care and insurance that they need of $74 million and that was computed by Department of Rev & Tax and the infrastructure itself would be between $30 million and $50 million dollars."

San Nicolas adds if the states choose to not establish an exchange, the federal government would step in and set up a federal facilitated exchange. However, it's a different story for the territories as Guam does not have that option as you either establish or not. "And if you don't establish an exchange, what kicks in is you get money allotted for Medicaid, not true Medicaid expansion but in Guam's case for example, we're going to get $24 million until 2019," he added.

And if you do the math, San Nicolas says it's actually not that much money a year. And once again, it's different for how this applies to the territories as San Nicolas says Guam can't use that funding unless it provides a 45% match to the 55% the feds kick in. The coverage for the States - 100%.

"Which is the exchange is covered, the planning and all the grants necessary to research whether an exchange can be established as well as the subsidies to carry out the function of the exchange and Medicaid expansion," he said.

San Nicolas says a billion dollars is parceled out to the territories with Puerto Rico receiving a major chunk - about $900 million to be exact. He adds trying to meet the match won't be easy, saying, "So it is a struggle."

A blueprint meanwhile is being finalized to help to address the gap for the nearly 30,000 Guamanians who are without insurance.