The Washington state health care exchange is not a done deal yet. More options could still be added. The board held up approval of the 31 plans OK'd by the insurance commissioner, but other companies can appeal next week.

Relief doesn't seem to be far away for Cleressa. Under health care reform, she will likely qualify for Medicaid. The only problem is that none of those plans made the cut for the Washington health care exchange. That's why four of those insurance companies -- Kaiser, Community Health Plan of Washington, Coordinated Care Company and Molina -- are now appealing.

Teresita Batayola runs the International Community Health Services in Seattle, where 30 percent of patients are uninsured. She said it's all about continuity of care. But the insurance commissioner's office said it's also about quality of care.

Deputy Commissioner Steve Valandra said the rejected plans had some serious flaws.

There was no children's hospital in a network. You didn't have access to a retail pharmacy, there was no burn unit in a network, you may have to travel 50 miles to see a cardiologist in an emergency, he said.

He said it was unacceptable. Additionally, all plans are required to accept Medicaid patients, so that many people will be able to stay with their current clinics.

Regardless of what happens with the appeals process, Michael Marchand said the exchange will still be ready to open for business as scheduled on October 1.

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