Sixteen states and the District of Columbia have submitted official letters to the Department of Health and Human Services (HHS) declaring their intent to establish state-based health insurance exchanges in compliance with the Patient Protection and Affordable Care Act (PPACA). Nevada is expected to submit its letter in the near future. Two states — Delaware and Illinois — have declared their intentions to pursue a partnership exchange in conjunction with the federal government, with five other states expected to follow suit. Eight states remain undecided or await further guidance from HHS.
Secretary of HHS, Kathleen Sebelius, extended the initial deadlines for state declaration letters, pushing back the cutoff for state exchanges to December 14 and for partnership exchanges to February 15, 2013. Those pursuing state-based exchanges must submit both their letters and their blueprint applications by December 14. In a letter responding to states’ requests for additional time, Secretary Sebelius reaffirmed that HHS is required by law to certify blueprints for state exchanges by January 1, 2013. States that still haven’t decided are likely to operate a partnership exchange or participate in a federally facilitated exchange.
Figure 1. State health insurance exchanges by model (as of December 4)
|Declared or expected state-based exchange ||Declared or expected partnership exchange ||Declared or expected federally facilitated exchange ||Waiting/undecided |
|California ||*Arkansas ||Alabama ||Florida |
|Colorado ||Delaware ||Alaska ||Idaho |
|Connecticut ||Illinois ||Arizona ||New Hampshire |
|District of Columbia ||*Michigan1 ||Georgia ||New Jersey |
|Hawaii ||*Montana ||*Indiana ||North Dakota |
|Iowa ||*North Carolina ||Kansas 2 ||Pennsylvania |
|Kentucky ||*West Virginia3 ||Louisiana ||Tennessee |
|Maryland || ||*Maine 4 ||Utah |
|Massachusetts || ||Missouri || |
|Minnesota || ||Nebraska || |
|Mississippi || ||Ohio || |
|*Nevada || ||Oklahoma || |
|New Mexico || ||South Carolina || |
|New York || ||South Dakota || |
|Oregon || ||Texas || |
|Rhode Island || ||Virginia || |
|Vermont || ||Wisconsin || |
|Washington || ||*Wyoming || |
* States expected to declare an exchange model.
1Although Governor Snyder filed a grant application on November 16 with HHS in order to collaborate on a partnership exchange, he has not yet submitted a formal declaration letter.
2Louisiana’s Secretary of the Department of Health and Hospitals submitted a letter to HHS on November 14, declaring the state’s decision not to pursue a state-based exchange.
3According to a press release issued by the West Virginia Office of the Insurance Commissioner on November 21, Governor Tomblin has decided to wait for further guidance from HHS before finalizing an exchange decision. The press release states that West Virginia tentatively plans to proceed with a partnership exchange.
4Missouri voters approved a ballot issue (62% voting in favor) on November 6 amending state law to prohibit the governor or other state agencies from establishing or operating a state-based exchange unless authorized by a vote of the legislature or a public referendum.
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