Twenty-eight States are on their way toward establishing a key component of health care reform-Affordable Insurance Exchanges-according to a report issued today by the White House.
"States are taking strong steps to implement health reform," said White House Deputy Chief of Staff Nancy-Ann DeParle. "The Obama Administration is working in partnership with State leaders across the country. We will ensure Americans in every State have access to an Exchange and the same kinds of insurance choices as Members of Congress."
Health Insurance Exchanges are State-based, one-stop marketplaces where consumers can choose a private qualified health insurance plan that fits their health needs. Beginning in 2014, Exchanges will offer consumers the same kinds of insurance choices that members of Congress will have.
The White House report provides an update on the process some States are using in moving forward on developing Health Insurance Exchanges. The States identified below are not necessarily the States most advanced in establishing an Exchange; instead, they illustrate the diversity of approaches and progress being made. Some of the actions in the report include:
- Alabama Governor Robert Bentley (R), a physician, issued an Executive Order that created the Alabama Health Insurance Exchange Study Commission on June 2, 2011, which recommended that Alabama establish its own Exchange called the "Alabama Health Insurance Marketplace." The legislature, which meets in February, is expected to take up legislation to establish an Exchange.
- Colorado passed a bipartisan bill to establish the independent Colorado Health Insurance Exchange, which was signed into law on June 1, 2011. The Colorado Exchange has started public education about health reform and the Exchange at its website, www.getcoveredco.org. Organizations such as the Colorado branch of the National Federation of Independent Business (NFIB) and the Colorado Association of Commerce and Industry have been active participants in the creating the small business component of the Exchange.
- In Nevada, unanimous, bipartisan legislation authorized the Silver State Health Insurance Exchange, which was signed into law by Governor Brian Sandoval (R) on June 16, 2011. Its board has been appointed, executive director named, and application submitted for its next round of funding for building the Exchange.
The report outlines some of the steps the Administration has taken to ensure all Americans have access to an exchange beginning in 2014. These include developing the information technology and business systems necessary to facilitate Exchanges in multiple states.
Developing Exchanges is just one of the ways States are implementing health reform. In the nearly two years since President Obama signed the Affordable Care Act into law, States have enforced the patient protections like banning lifetime dollar limits on coverage and ensuring coverage of proven prevention services. Forty-three States and the District of Columbia are participating in the new premium rate review system where insurers must justify the rationale for any double-digit insurance premium increase. All States have received Affordable Care Act grants to improve prevention and public health. And the Affordable Care Act has already made an incredible difference to millions of Americans:
- 2.5 million more young adults have health insurance.
- As of October 2011, more than 2.65 million seniors got a 50 percent discount on their prescription drugs when they hit the donut hole.
- Insurance companies can no longer drop your coverage when you get sick or put a lifetime cap on the amount of care you can receive.
States Going Another Route
That's all good, but there's another side to this story. Because 27 states and Washington, D.C. are well on their way to health insurance exchange development, obviously 22 states have something else in mind. So let's look a bit further:
- Wisconsin decided on January 18th that it will turn down $37 million from the federal government that had been awarded to help implement health care exchanges under President Barack Obama's health care reform law. Wisconsin had been developing an innovative health insurance exchange but Governor Scott Walker said he was notifying the federal government that Wisconsin was turning down the Early Innovator Grant. "Stopping the encroachment of ObamaCare in our state, which has the potential to have a devastating impact on Wisconsin's economy, is a top priority. Wisconsin has been a leader and innovator in health care reform for two decades, and we have achieved a high level of health insuranEce coverage without federal mandates."
- Wyoming is awaiting a U.S. Supreme Court ruling on the constitutionality of the PPACA, it must also look at future health care needs in Wyoming. "The governor opposes the Affordable Care Act, and we’ve joined the lawsuit against it, but it doesn’t do us any good if we don’t have an alternative to the challenges of accessing and paying for health care in the state," a state spokeswoman said Wednesday.
- Ohio is a very interesting case. When it comes to federal health reform, the Kasich administration seems to be of two minds, according to the Lancaster Eagle Gazette. One of Gov. John Kasich's top appointees, Greg Moody, has enthusiastically embraced a key goal of health reform: boosting quality and moving toward more preventive, coordinated care. But a second official, Lt. Gov. Mary Taylor, who Kasich tapped to head Ohio's insurance department, has impeded implementation of the Affordable Care Act, calling it a "catastrophic law." "It's like the good witch and the bad witch in 'The Wizard of Oz,'" said Cathy Levine, executive director of Ohio Consumers for Health Coverage. Moody and others in the Office of Health Transformation "are availing themselves of the tools in the Affordable Care Act to achieve the triple aims of better care, better health and lower costs," Levine said. But Taylor and the Ohio Department of Insurance are "boycotting the Affordable Care Act." Moody and Taylor disputed that assessment. "Our position in the administration has been very clear, and we are all on the same page," Taylor said. Kasich and his appointees believe health reform "should be repealed and replaced, and we're really concerned about the mandates that are being forced on states.
Waiting on the Supreme Court?
We're all waiting for the Supreme Court decision on the PPACA, but the action in the states is where its really getting interesting right now.
