State Health Insurance Exchanges: A Snapshot

STATELINE INFOGRAPHIC Health Exchanges: A Snapshot The Affordable Care Act requires nearly everyone to have health insurance by January 1, 2014. The federal health law gives states the option of creating health insurance exchanges through which their residents can purchase coverage. With a presidential election on the horizon and a November 16 deadline for states to declare their intentions and readiness to build an exchange, the majority of states are expected to let the federal government take over by default. Jan. 2013 Jan. May-Aug. 2012 June-Nov. 2012 Level two Nov. 2014 2012 States file Federal Exchange insurance Mar. Level one inspection of state 2009 ACA enacted grants awarded grants awarded exchange "blueprints" becomes exchanges effective 2009-2010 2012 2013 2014 June 2012 Nov. Sept. 2010 Oc. 2012 2013 $1M planning grants awarded Supreme Presidential Health Court elections insurance upholds exchanges ACA open Health insurance exchange status Only 15 states and the District of Columbia have chosen to establish state exchanges. Plagued by political rancor stemming from the nation's sharp divide over the law, most states have been unable to enact the needed laws to initiate the massive project. Established state exchanges (15+ DC) WA Planning for partnership exchange (3) ME MT ND OR MN No significant activity (25) ID SD NY Decision not to create state exchange (7) WI WY IA PA NV NE OH IL IN UIT Co KS MO VA Half of all states have KỲ failed to adopt their own exchanges. Among those, several have accepted federal implementation grants. A few have made significant progress in building the needed infrastructure for a state NC 2/ TN OK AZ NM AR SC MS AL GA LA TX HI exchange. *Utah has a health insurance exchange for small businesses that was piloted before the Affordable Care Act was enacted. The state has failed to enact a law bringing the exchange into compliance with the federal law. State exchange implementation grants The amount of money states are receiving from the federal government has little to do with population and more to do with the features and functions states choose to include in their exchanges. As long as states can justify the expenses, the federal law requires Washington to pay the full tab. By October 15, 2014, states must let the federal government know what the final payment will be. A few states already have. $250M Planning grants of $1M Total initial payments Final payments In 2010, every state except Alaska received a $1M planning grant. After that, states could apply for additional implementation money as they made decisions about the scope and cost of their exchanges. 200M 150M 100M 50M $1M AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MAMDME MI MNMOMS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI wwWY How a health exchange works AT A GLANCE While state exchanges are expected to vary widely, the law requires certain basic elements. Who can use an exchange? CONSUMER EXCHANGE Application for public health plans or tax credits Comparison of insurance Enrollment in a plan Uninsured individuals and those who pay for their own insurance but want to find a cheaper policy are expected to use exchanges. Anyone who does not have either IRS Private insurance Forms employer-sponsored Social Security Medicaid Payment options insurance or Medicaid is Medicaid CHIP eligible. State or locally funded health plan DATA Businesses with fewer than 100 employees can purchase employee policies through an exchange provided the average of all salaries is below $50,000 per year. Most companies are expected to continue purchasing insurance the way they always have. But for businesses seeking plans that have not been previously available, exchanges will offer new options. SMALL BUSINESS EXCHANGE Assessment of tax credit Comparison of insurance Enrollment in a plan eligibility IRS Private insurance Forms Payment options DATA Sources: Kaiser Family Foundation; Center on Budget and Policy Priorities; U.S. Department of Health and Human Services Stateline infographic by: Adam Rotmil, Christine Vestal, and Carla Uriona. September 5, 2012.