Update on States’ Progress in Implementation of Health Insurance Exchanges

Since we last looked at the states’ implementation of the health insurance exchanges required under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), several states have made significant progress, but there have been setbacks as well. The nonpartisan Center for Budget and Policy Priorities (CBPP) recently released a report on the status of legislation and executive action to establish the exchanges.

CBPP reports that at last count, 29 states have received grants from HHS to go beyond the planning stage and begin setting up the necessary infrastructure. Another seven previously  received “Early Innovator” grants and would be expected to have made substantial progress. However, two of the early innovators, Kansas and Oklahoma,  returned their grants, and Wisconsin announced recently its intention to do so.

Legislation.   The District of Columbia passed legislation to establish an exchange in December, and the Mayor signed it into law on January 13, 2012. According to CBPP’s comprehensive analysis,  in North Dakota, a bill introduced during a special session was voted down November 10, 2011.  Since August 2011, legislation to establish an exchange has been introduced in the following states:

  • Wisconsin: S 273 was introduced  on November 1st and was referred to the Health Committee.  However, on January 18, 2012, Governor Walker announced that the state would return its $38 million Early Innovator grant.
  • Idaho: Legislation has been drafted and was considered by the state health care task force on January 6, 2012.  The legislative session has just begun.
  • Virginia:  Three bills were introduced on January 10, 2012 and were referred to committee.
  • Michigan:  The state Senate passed SJ91 on November 10, 2011.  The House has referred the bill to the Health Policy committee.
  • New Mexico:  SB6 was introduced December 15, 2011; last year the legislation passed but was vetoed by the Governor.
  • Ohio:  SB 277 was introduced on January 3, 2012.
  • Nebraska: LB835 and LB 838 were introduced on January 5, 2012.
  • New Jersey:  A revised bill was introduced  on January 10, 2012; an earlier version passed the Assembly last year.
  • Iowa: Legislation was introduced on January 23, 2012, CBPP reports.

Legislation also failed in Georgia last year. Governor Nathan Deal then appointed an advisory committee to explore the possibilities and issues involved with establishing an exchange. Despite the committee’s report recommending action, the chair of the Senate Health and Human Services Committee announced on January 11th  that the legislature will not consider the issue this year; the governor agreed not to push it.

Executive Action:  Governor Lincoln Chafee of Rhode Island issued an executive order on September 19, 2011, directing the  establishment of an exchange.  Rhode Island is the only state to have received a stage 2 grant to proceed with implementation.

According to CBPP, Arizona officials in stated in a January 5, 2012 planning grant report to CMS that they were investigating whether an exchange could be established through executive action.  Last spring, Mississippi’s Insurance Commissioner announced that the exchange would be established using existing authority under state law.  The Arkansas Insurance Commissioner apparently was considering a similar move, but on December 2, 2011 announced that planning efforts had ceased.

Idaho’s Department of Health and Welfare has worked extensively on preparation for the exchange and received a level 1 establishment grant. The state’s joint legislative committee  recommended passage of the legislation, and it seems to have the support of the business community. However, the Governor Butch Otter told reporters on January 25, 2012 that the state was out of time and probably could not establish an exchange by the 2013 deadline.

Opponents of the exchange legislation argue that there is no point in acting until the Supreme Court rules on its constitutionality. The ruling is anticipated by July, just in time for the 2012 presidential campaign.