Thus far states that have moved slowly on health exchange development. In states that refuse, the law allows the federal government to step in.
Background
Under the federal health care reform law, the Patient Protection and Affordable Care Act (PPACA) an exchange must be available in each state by 2014. The health insurance exchanges wilol serve as an entry point and comparative shopping marketplace for that portion of the public for whom insurance traditionally has been especially expensive: Americans who buy coverage on their own, or as part of small companies. The exchanges are supposed to make it easier for them to compare health plans while creating pools of customers large enough to slow rising prices.
The states must prove to federal health officials that they are on a path to be ready for health insurance exchange implementation by January 2013.
So where are the state's in the health insurance exhange imnplemntation process?The furthest along are seven states that have adopted laws establishing their exchanges. California did so last year, followed this year by Colorado, Hawaii, Maryland, Vermont, Washington and West Virginia. Two others, Virginia and North Dakota, passed laws expressing their intent to form an exchange, without spelling out details of how it should be run, according to The Washington Post. Both states have Republican governors who oppose the federal law but maintain it would be worse to entrust an exchange to the federal government.
Seven other states, including some with GOP leadership, have not passed any relevant legislation but have accepted federal grants to prepare key components of the exchanges, including systems to determine which residents are eligible.
Alabama
Governor Robert Bentley (R) issued an executive order in May 2011 to move forward on an Alabama health insurance exchange and lashed out at the state’s Republican-controlled Legislature for attempting to scale back his proposed $247 million increase in Medicaid funding by a mere $7 million.
Alaska
Currently planning not to comply with law after Florida court ruling that PPACA is unconstitutional. Legislation has been introduced to establish an exchange. Did not apply for an HHS Planning and Implementation Grant.
Arizona, Arkansas, Colorado, Delaware, District of Columbia
All received $1 million planning grants for health insurance exchange implementation.
Connecticut
State Representatives have voted to establish a quasi-public agency to launch and run a health insurance exchance that will play a key role in expanding coverage under the federal health reform law. The exchange will have a wide range of responsibilities and offer a choice of health plans--all or most are expected to be from private insurance carriers--to individuals and small businesses, including those who qualify for federal subsidies to buy coverage.
Florida
Governor Rick Scott decided to wait for a Supreme Court ruling before continuing with implementation. As a result, the state has rejected $2 million in federal grants: $1 million awarded to begin implementation planning of health insurance exchanges, and another $1 million that would have provided a system for consumers to monitor insurance-rate changes and how premiums are spent.
Georgia
Governor Deal signed an executive order in early June creating the Georgia Health Insurance Exchange Advisory Committee. The panel will determine if Georgia should establish state-based health care exchanges under federal health care reform.
Hawaii, Idaho, and Illinois, Iowa
All received $1 million planning grants for health insurance exchange development.
Indiana
Governor Daniels, created Executive Order 11-01 to establish the Indiana Health Benefit Exchange. Received $1M planning grant.
Kansas
Received $1M planning grant. Received $31 million “Early Innovator” grant to build exchange infrastructure.
Kentucky
In Kentucky, where Democrats control the governor’s office and the House of Representatives, Rep. Tom Burch (D), who heads the Health and Welfare Committee, said his party was simply waiting for the Obama administration to issue regulations spelling out federal requirements in more detail. “So much of this stuff is still speculation,” he said.
Louisiana
The Louisiana Insurance Commissioner expects to begin releasing details about Louisiana’s plans for the exchange by the end of 2011.
Maine
Received $1M planning grant. Part of 5-state consortium receiving a $35 million “Early Innovator” grant to build exchange infrastructure.
Maryland
Received $1M planning grant. Received $6 million “Early Innovator” grant to build exchange infrastructure.
Massachusetts
Existing exchange, the Commonwealth Health Insurance Connector, already in place. Received $1M planning grant (to be used to ensure that plans in the Connector meet federal requirements).
Michigan, Mississippi, Missouri, Nebraska, Nevada,
All received $1 million planning grants for health insurance exchange development.
Minnesota
Governor Tim Pawlenty signed Executive Order 10-12 in August 2010 that prohibited all executive department and state agency participation in federal health reform unless required by law or directed by the governor’s office.
Montana
State Auditor Monica Lindeen, whose office regulates insurance, says she expects the federal government to start building Montana's health insurance exchange, which is an Internet shopping center for health insurance policies, as required under federal law. The Republican-controlled Legislature rejected bills that would have set up the framework for a state-designed exchange. Instead, it directed a panel to study the issue.
New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio
All received $1 million planning grants for health insurance exchange development.
Oklahoma, Oregon
Each received $1M planning grants and received $48+ million “Early Innovator” grant to build exchange infrastructures in their states.
Pennsylvania, South Carolina, South Dakota, Tennessee
All received $1 million planning grants for health insurance exchange development.
Rhode Island, Vermont
Received $1M planning grants. Both are part of 5-state group receiving the “Early Innovator” grant to build exchange infrastructure.
Texas
Officials at the Texas Department of Insurance have since last fall, with the help of a $1 million grant from the United States Department of Health and Human Services, they have been working quietly to plan for a health insurance exchange. “We’ve been going full speed ahead on implementation, doing the due diligence so that we can be on time with what the law says,” said John Greeley, a spokesman for the agency.
Utah, Virginia, West Virgina
Received $1M planning grants.
Washington
Received $1M planning grant. Washington already has in place an exchange serving small employers.
Wisconsin
Received $1M planning grant. Received $37 million “Early Innovator” grant to build exchange infrastructure. Also established the Office of Free Market Healthcare to explore free market innovation within its health insurance exchange implementation.
Wyoming
Received $800,000 planning grant.
Information compiled from various sources including The Washington Post and Extendhealth.com
