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Status of State Health Insurance Exchanges

11/15/2012 - 12:15pm
Status of State Health Insurance Exchange Decisions Map

By John Vinci (@jcvinci)

(Updated 1/4/2012 8:49am) Governors and other state officials, across the states, are deciding whether their state will establish a Health Insurance Exchange. The Department of Health and Human Services has given States until Friday, December 14, 2012 to decide. We have been following this issue closely and here's the status of the states as best as we can tell.

States NOT establishing a State Exchange (26):

ALABAMA
ALASKA
ARIZONA
FLORIDA
GEORGIA
INDIANA
KANSAS
LOUISIANA
MAINE
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEW HAMPSHIRE
NEW JERSEY
NORTH DAKOTA
OHIO
OKLAHOMA
PENNSYLVANIA
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
VIRGINIA
WISCONSIN
WYOMING

Undecided States (0):

States establishing a federal "partnership" Exchange(7):

ARKANSAS
DELAWARE
IOWA
ILLINOIS
MICHIGAN
NORTH CAROLINA
WEST VIRGINIA

States planning to establish a State Exchange (17):

CALIFORNIA
COLORADO
CONNECTICUT
HAWAII
IDAHO
KENTUCKY
MARYLAND
MASSACHUSETTS
MINNESOTA
NEVADA
NEW MEXICO
NEW YORK
OREGON
RHODE ISLAND
UTAH
VERMONT
WASHINGTON

Notes:
AL: Gov. Bentley says Alabama won't set up exchange, expand Medicaid , AL.com (11/14/2012)

AR: Beebe: State to pursue partnership health insurance exchange, Arkansas News Bureau (December 12, 2012).

AZ: Letter from Gov. Janice K. Brewer to Gary Cohen, Director, Office of Consumer Information and Oversight, Office of the Secretary, Department of Health and Human Services (November 28, 2012). See also, Office of Gov. Janice K. Brewer, Press Release, Statement by Governor Brewer: Too Many Questions, Costs with State Health Exchange, (11/28/2012).

CA: Letter from Gov. Edmund Brown, Jr. to Kathleen Sebelius, Secretary, Department of Health and Human Services (July 10, 2012).

CO: Letter from Gov. John Hickenlooper to Steve Larsen, Deputy Administrator and Director of CCIIO at the Centers for Medicare and Medicaid Services (July 7, 2012).

CT: Letter from Gov. Dannel Malloy to Kathleen Sebelius, Secretary, Department of Health and Human Services (July 10, 2012).

DE: State Exchange Profiles: Delaware, KFF.org(Sept. 24. 2012)

FL: Friday deadline passes, still no Florida health-insurance exchange decision Jacksonville Business Journal (December 17, 2012).

GA: Office of Governor Nathan Deal, Press Release, Deal: Georgia will not set up state exchange, (11/9/2012)

HI: Letter from Gov. Neil Abercrombi to Steve Larsen, Deputy Administrator and Director of CCIIO at the Centers for Medicare and Medicaid Services (July 7, 2012).

ID: Office of Butch Otter, Governor of the State of Idaho, News Release, GOVERNOR OPTS FOR STATE-BASED EXCHANGE: LEGISLATURE STILL MUST WEIGH IN ON HEALTH INSURANCE ISSUE (12/12/2012)

IL: Illinois moves ahead on health insurance exchange, BloombergBusinessWeek (11/6/2012)

IA: Letter from Gov. Terry Branstad to Kathleen Sebelius, Secretary, Department of Health and Human Services (December 14, 2012).

IN: Pence not ruling out health partnership with feds, WSBT.com (11/14/2012)

KY: Letter from Gov. Steven Beshear to Kathleen Sebelius, Secretary, Department of Health and Human Services (July 10, 2012).

MA: Letter from Gov. Deval Patrick to Mike Hash, Interim Director of CCIIO at the Centers for Medicare and Medicaid Services (July 10, 2012).

MD: Letter from Gov. Martin O'Malley to Kathleen Sebelius, Secretary, Department of Health and Human Services (July 10, 2012).

ME: Maine may give warmer embrace to Obama health law, The Boston Globe (11/10/2012)
On eve of PPACA exchange deadline, many governors still balk, Employee Benefit News (11/15/2012)

MI: Gov. Snyder has filed an application for a grant to establish a "partnership" Exchange. We are, however, leaving Michigan's "undecided" status unchanged because according to the governor's press release, he says the state may yet consider its own exchange and "has not yet filed a declaration letter formally choosing Michigan's path." Office of Gov. Rick Snyder, Press Release, Michigan moves toward state-federal partnership health exchange, leaves door open for MI Health Marketplace (11/16/2012)
Update 12/17/2012: As Michigan did not notify HHS of any intention to establish a state exchange, they are expected to have a federal "partnership" exchange for 2014.

MN: Election clears path for health exchange, Winona Daily News (11/9/2012)

MO: Missourians passed a referendum this month that prohibits its governor [who supports a state exchange] from acting unilaterally

MS: Insurance Commissioner Says Its [sic] now Impossible To Operate State Health Exchange, supertalk.fm (1/4/2013)

MT: PoliticoPro reported on 11/16/2012 that a state official confirms Montana's governor will not be establishing a state exchange.

NC: Press Release Gov. Perdue Chooses State-Federal Partnership (11/15/2012)

ND: ND direction on health care exchange to emerge next year, Prarie Business Magazine (11/15/2012)

NE: Press Release: Gov. Heineman on Federal Health Care Law: $646 Million State Exchange Too Costly (11/15/2012)

NH: New Hampshire's new governor may attempt to move towards establishing an exchange but we have left it in the "No state Exchange" category based on past legislation signed by the governor that blocked the Exchange. See http://www.cato-at-liberty.org/new-hampshires-democratic-governor-signs-gop-bill-blocking-obamacare-exchange/ .

NJ: John Reitmeyer, NorthJersey.com, "Christie vetoes state-run health exchange bill," (Dec. 6, 2012, 12:56 PM) available at: http://www.northjersey.com/news/Christie_vetoes_state-run_health_exchange_bill.html .

NM: New Mexico moves ahead with health exchange, CBS News (11/15/2012)

NY: Letter from Gov. Andrew Cuomo to Mike Hash, Interim Director of CCIIO at the Centers for Medicare and Medicaid Services (July 9, 2012).

OH: Ohio to let federal government run insurance exchange required by health care law, The Plain Dealer (11/13/2012)

OK: Office of Gov. Mary Fallin, Press Release, Gov. Fallin: Oklahoma Will Not Pursue a State-Based Exchange or Medicaid Expansion (11/19/2012)

OR: Letter from Gov. John Kitzaber to Steve Larsen, Deputy Administrator and Director of CCIIO at the Centers for Medicare and Medicaid Services (July 6, 2012).

PA: ID: Pennsylvanial Office of the Governor, News Release, Governor Corbett Announces State-Based Insurance Exchange Decision (12/12/2012)

RI: Letter from Gov. Lincoln Chafee to Kathleen Sebelius, Secretary, Department of Health and Human Services (July 5, 2012).

SC: Letter from Gov. Nikki Haley to Kathleen Sebelius, Secretary, Department of Health and Human Services (November 15, 2012).

SD: Press Release from the Office of Gov. Dennis Daugaard: South Dakota Will Not Build Health Insurance Exchange, (9/26/2012)

UT: Utah faces deadline for decision on health exchange, The Salt Lake Tribune (11/15/2012)

TN: Press Release, News.TN.gov, "Haslam Announces State Will Not Run Health-Care Exchange" (11/14/2012) available at https://news.tn.gov/node/10017.

UT: Casa Grande Tribune, "", (12/15/2012).

VA: Post-election, McDonnell says Virginia will default to federal health insurance exchange, The Washington Post (11/8/2012)

VT: Letter from Gov. Peter Shumlin to Steve Larsen, Deputy Administrator and Director of CCIIO at the Centers for Medicare and Medicaid Services (July 9, 2012).

WA: Letter from Gov. Christine Gregoire to Mike Hash, Interim Director of CCIIO at the Centers for Medicare and Medicaid Services (July 10, 2012).

WI: Letter from Gov. Scott Walker to Kathleen Sebelius, Secretary, Department of Health and Human Services (November 16, 2012).

WV: Ashton Marra, West Virginia Public Broadcasting, "Gov's Chief of Staff explains state's mandatory healthcare exchange options," (12/11/2012).

WY: See Feds To Control Wyoming Health Care, Wyoming Tribune-Eagle (11/14/2012).


Updated 11/15/2012 12:08 to add notes.
Update 11/15/2012 2:54pm:
New Mexico changed to "Establishing a state Exchange." (See New Mexico moves ahead with health exchange)
Delaware, Illinois, and North Carolina changed to "Establishing federal Partnership Exchange." (See Gov. Perdue Chooses State-Federal Partnership)
Utah changed to undecided (See Utah faces deadline for decision on health exchange [The Salt Lake Tribune])
Update 11/15/2012 3:37pm:
Nebraska changed to "NOT establishing a state Exchange." (See Press Release: Gov. Heineman on Federal Health Care Law: $646 Million State Exchange Too Costly)
New Mexico color was corrected on map
Update 11/15/2012 4:03pm:
Adding notes with links to letters from state governors to the Obama Administration stating intent to create an exchange (California, Colorado, Connecticut, Kentucky, Hawaii, Massachusetts, Maryland, New York, Oregon, Rhode Island, Vermont, Washington)
Update 11/15/2012 4:08pm:
Adding notes with links to letter from South Carolina Governor, Nikki Haley to the Obama Administration stating intent NOT to create an exchange.
Update 11/15/2012 4:14pm:
Added link in notes to article that confirms Maine Gov. Paul LePage has no plans to establish a state health insurance exchange.
Update 11/15/2012 9:48pm: Changed deadline from 11/15/2012 to 12/14/2012 to reflect the extension communicated by Sec. Sebelius' to the Republican Governors Association.
Update 11/16/2012 10:10am: Changing Montana to "NOT establishing a state exchange" based on a report that a Montana official confirmed that Governor Brian Schweitzer will not be establishing a state Exchange.
Update 11/16/2012 10:56am: Changing Montana to "NOT establishing a state exchange."
Update 11/16/2012 3:45pm:
Changed GA to "Not establishing a state Exchange."
Changed FL to "Undecided."
Changing IA to "Undecided" based on 11/16/12 letter to HHS (see notes).
Added notes for AR, DE, IA, and ID.
Updated Notes for WI, WV.
Update 11/16/2012 4:03pm: Correcting map image which didn't have the right color for Florida.
Update 11/19/2012 8:24am: Updating note on Michigan.
Update 11/19/2012 3:02pm:
Changing OK to "Not establishing a state Exchange."
Update 11/28/2012 4:58pm:
Changing AZ to "Not establishing a state Exchange."
Update 11/29/2012 9:33am:
Changed color for Partnership Exchange states to blue on map.
Update 12/6/2012 1:00pm:
Changing NJ to "Not establishing a state Exchange."
Update 12/10/2012 2:27pm:
Changing TN to "Not establishing a state Exchange."
Update 12/12/2012 8:35pm:
Changing ID to "Establishing a state Exchange."
Updating note for ID.
Update 12/12/2012 1:51pm:
Changing PA to "Not establishing a state Exchange."
Updating note for PA.
Changing AR to "Not establishing a state Exchange."
Updating note for AR.
Changing AR to "States establishing a federal 'partnership' Exchange"
Updating note for AR.
Update 12/13/2012:
Changing IA to "States establishing a federal 'partnership' Exchange"
Updating note for IA.
Update 12/17/2012 1:51pm:
Changing WV to "States establishing a federal 'partnership' Exchange"
Updating note for WV.
Changing MI to "States establishing a federal 'partnership' Exchange"
Updating note for MI.
Changing FL to "Not establishing a state Exchange."
Updating note for FL.
Changing UT to "Establishing a state Exchange."
Adding note for UT.
Changing MS to "Not establishing a state Exchange."
Updating note for MS.