The Affordable Care Act (ACA) requires each state to have a health insurance exchange through which low and moderate-income individuals can purchase private health coverage at subsidized rates. In line with the mandate that each individual have health insurance by 2014, the exchanges are likewise required to be fully operational in each state by January 1, 2014. (Open enrollment for the exchanges begins October 1, 2013.) The ACA allows each state the choice of how to establish the health insurance exchange. States can opt to create their own state-based exchanges, partner with the federal government to create a state-federal exchange, or have an entirely federally created and facilitated exchange. The deadline for states to decide whether they will be creating their own state-based exchange is Friday, November 16th. However, in a November 9th letter to state governors, Secretary of Health and Human Services announced an extension of the deadline for completing the “blueprint” of implementation to Friday, December 14th, 2012.
Where do the states currently stand? As of November 9, 2012, the Kaiser Family Foundation lists the status of the states as follow:
Established State Exchange (16): California, Colorado, Connecticut, District of Columbia, Hawaii, Kentucky, Maryland, Massachusetts, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington, West Virginia
Planning for Partnership Exchange (4): Arkansas, Delaware, Illinois, Michigan
Decision Not to Create State Exchange (11): Alaska, Florida, Kansas, Louisiana, Maine, Missouri, New Hampshire, South Carolina, South Dakota, Texas, Virginia
Studying Options (14): Alabama, Arizona, Idaho, Indiana, Iowa, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, North Carolina, Pennsylvania, Tennessee
No Significant Activity (6): Georgia, North Dakota, Ohio, Oklahoma, Wisconsin, Wyoming
Source: Kaiser Family Foundation. “State Action Toward Creating Health Insurance Exchanges, as of November 9, 2012. https://statehealthfacts.kff.