MONTGOMERY — Alabama’s governor and others around the nation have one week to let the federal government know if their states will run their own health care exchange programs under the Affordable Care Act.

It is one of several major decisions regarding the national health care reform program and Medicaid that state leaders have to decide soon.

But some Alabama lawmakers Thursday lamented that they don’t yet have all the information they’d like from the federal government about the act’s mandates.

Exchanges are health insurance markets where small businesses and individuals can shop for private coverage from various insurers. States must declare by Nov. 16 whether they will run their own and provide a blueprint for what it will look like, or whether they’ll accept a federally run exchange or some hybrid of both.

“We don’t really have much information on how the federal exchanges are going to work, or how the cooperative agreements will work,” said Joy Wilson, health policy director for the National Conference of State Legislatures. Wilson held a teleconference Thursday morning with lawmakers on the Legislative Medicaid Advisory Committee.

Several Democratic and Republican lawmakers have said the state should control its own exchange, but they’d like to know more about the federal option.

“We are going to make a decision on what is best for the people of Alabama, and we don’t have all the information,” said committee co-chairman and state Sen. Greg Reed, R-Jasper.

As of late September, 19 states had started setting up exchanges or agreed to do so in partnership with the federal government, according to the Kaiser Family Foundation.

In the meantime, Republican governors in Texas, Florida, Mississippi, South Carolina, Louisiana and Georgia have said they will not participate.

At least one state lawmaker said Bentley should say no as well.

“The feds have given us these deadlines, but they don’t have anything to show us,” said Rep. Ed Henry, R-Hartselle, who was recently appointed by Bentley to a commission to study rising Medicaid costs.

More than 30 million uninsured people nationwide are expected to gain coverage under the Affordable Care Act, The Associated Press reported Thursday. About half will get private insurance through the exchanges. The rest, mainly low-income adults without children at home, will be covered through Medicaid expansion.

In Alabama, some lawmakers have expressed concern over expanding the rolls — even if the federal government will pay a majority of the cost — because Medicaid already gets about 36 percent of the state’s general fund. About 20 percent of the Alabama population, including many children, receive Medicaid benefits.

Wilson said Thursday that states can increase the number of people who receive health care benefits from Medicaid, then reduce it later. But that’s not something she necessarily recommends.

“It would be difficult for a state to expand coverage to a large group of people, and then take it away,” Wilson said. “But it is an option that is available.”

Medicaid funding will be a major issue for the Legislature when it meets for a new session in February. They’ve already been warned that even if no changes are made to current Medicaid benefits, the cost in the next budget year will increase significantly.

“The Medicaid of the future will not be Medicaid of the past, it just won’t be, for all types of reasons,” said Medicaid committee co-chair Rep. Greg Wren, R-Montgomery.

Mary Sell can be reached at mary.sell@TimesDaily.com.