Which states have implemented the Health Insurance Exchanges included in the Affordable Care Act (a.k.a. Health Reform, a.k.a. ObamaCare)?
According to the Kaiser Family Foundation, 16 States have already established a state exchange, 3 are planning for Partnership Exchange, 16 are Studying Options and 9 have had no significant activity on this front. Most strikingly, 7 States decried not to create an exchange. What did your state decide? The answer after the jump.
- Decision Not to Create State Exchange. Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, and Texas.
- Established State Exchange. California, Colorado, Connecticut, District of Columbia, Hawaii, Kentucky, Maryland, Massachusetts, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington, West Virginia.
- No Significant Activity. Georgia, Kansas, Missouri, North Dakota, Ohio, Oklahoma, South Dakota, Wisconsin, Wyoming.
- Planning for Partnership Exchange. Arkansas, Delaware, Illinois.
- Studying Options. AAlabama, Arizona, Idaho, Indiana, Iowa, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, North Carolina, Pennsylvania, Tennessee, Virginia.
Of the states who have decided to set up an Exchange, one can further identify structure and type of exchange.
Structure of Exchange
- Non-Profit. Hawaii.
- Operated by State. Kentucky, New York, Rhode Island, Utah, Vermont, West Virginia.
- Non-Profit. California, Colorado, Connecticut, District of Columbia, Maryland, Massachusetts, Nevada, Oregon, Washington.
Types of Exchange
Five states (Kentucky, New York, Nevada, Washington, West Virginia) have not yet addressed the type of exchanged that will be established. Maryland’s type of Health Insurance Exchange (HIE) will be decided by the Board of Directors. Among those who have already selected the type of exchanges, these States choose between active purchaser and clearinghouse models. The active purchaser model seeks to leverage the HIE’s authority and market power to promote value for the consumer. Active purchasers can use a range of tools under its administrative authority from regulation, negotiation, and consumer education, to oversee the insurance market to minimize any gaming by insurers. In the clearinghouse model, the State does not directly negotiate rates with plans, rather all qualified insurers meeting minimum standards may participate in the Exchange. The HIE serves as a one-stop shop where consumers find accessible and useful easy to understand information on a wide variety of health plans. The list below describes which states selected each model.
- Active Purchaser. California, Connecticut, District of Columbia, Massachusetts, Oregon, Rhode Island, Vermont.
- Clearinghouse. Colorado and Hawaii.
Who supports each type of model? We have some evidence from a stakeholder survey from New Jersey:
Consumer groups argued for the exchange to negotiate better rates, set high standards for plans, provide oversight, including helping to “police” minimum benefits and ensuring adequate provider networks, and provide quality information to help consumers compare plans. More than other constituencies, consumer groups believed that an active purchaser model could also facilitate improvements in the affordability and quality of care by negotiating with carriers. Conversely, carriers and brokers would opt for a clearinghouse model exchange, believing that it should promote competition among all qualified plans, and citing the series of regulatory protections that New Jersey already had in place. Employer groups and provider constituencies offered mixed responses on this question.