States to Decide Today How They Will Implement Their ‘Affordable Insurance Exchanges’

WASHINGTON, D.C.—Today is the deadline for states to apply to operate a state-based Affordable Insurance Exchange as required by the Patient Protection and Affordable Care Act (ACA). States planning to operate a federal/state partnership exchange have until Feb. 15, 2013 to apply. Those states that do not apply will default to a federally run exchange. A state may apply at any time to run an exchange in future years. Exchanges will have to start enrolling people in Oct. 2013 and be fully operational by Jan. 1, 2014.

As of press time, 18 states and the District of Columbia have applied to operate a state-based exchange, six have opted for a federal/state partnership, and 24 states will default to a federally run exchange. Florida will not make a decision until the 2013 legislative session. Utah passed legislation in 2008 and 2009 to create a health insurance exchange for small businesses, but because it is not considered compliant with ACA, Utah Governor Gary Herbert (R) wrote a letter to President Obama on Tuesday, Dec. 11, 2012, seeking help in getting it approved.

The breakdown of each state’s decision is as follows:

State based—California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington.

Federal/state partnership—Arkansas, Delaware, Illinois, Michigan, North Carolina, West Virginia.

Default to federally run—Alabama, Alaska, Arizona, Georgia, Indiana, Kansas, Louisiana, Missouri, Montana, Maine, Nebraska, New Jersey, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, Wyoming.

For a color-coded map of each state’s exchange decision and for a detailed chart indicating the structure and type of exchange being created and whether the exchange decision was made legislatively or by the executive branch, see the Henry J. Kaiser Family Foundation website at