Under the Patient Protection and Affordable Care Act, states must establish health insurance exchanges by Jan. 2014 or invite the federal government to step in and take over implementation. The exchanges, which would function as a marketplace for individuals and small businesses, are intended to help consumers negotiate for cheaper rates and lower insurance costs overall. Here are 15 states that have enacted legislation to establish, plan for or examine the feasibility of health insurance exchanges.
1. California. California was the first state to pass an exchange bill following healthcare reform in fall 2010. The state included a statement that the exchange could be an active purchaser but left specific details up to the governing board. The governing body will be comprised of five members, and the structure of the exchange is expected to be quasi-governmental.
2. Colorado. Colorado recently appointed Joan Henneberry to direct the state's health insurance exchange program, which she describes as "like Travelocity or Expedia for health insurance," according to a Chieftain report. Colorado's exchange will be structured as a quasi-governmental clearinghouse and governed by a board of 12 members.
3. Connecticut. Connecticut is currently in the process of choosing a board and staff members to oversee the development of its health insurance exchange. In Sept. 2010, the state received a one-year planning grant of $996,848 from the federal government and is now applying for $6.6 million more to pay for a second phase of development. Connecticut's exchange will be an active purchaser governed by 14 board members who represent healthcare finance and benefit administration, health economists and experts on health insurance coverage for individuals and small employers.
4. Hawaii. Hawaii's health insurance exchange will be structured as a non-profit clearinghouse, governed by 15 members until the replacement of the state's interim board on June 30, 2012. Once that board is replaced, the board of directors will include 11 members appointed by the governor, with advice and consent from the Senate. The members will include healthcare consumers, hospital trade associations and insurers.
5. Illinois. Recently approved Illinois legislation set up a 12-member legislative study committee to recommend a structure for the Illinois Health Benefits Exchange. The study committee must submit its report to the Illinois General Assembly and the governor by Sept. 30.
6. Maryland. According to Maryland Secretary of Health and Mental Hygiene Josh Sharfstein, Maryland has faced "fierce" IT challenges in developing its health insurance exchange because of the need for seamless integration between the state health program's eligibility system and the exchange. Maryland will have a quasi-governmental structure to be decided by the board of directors, a panel of nine members.
7. Mississippi. The Mississippi Insurance Department is planning to travel throughout the state in the coming weeks, speaking to employers and business owners regarding the state's proposed health insurance exchange in a series of town hall meetings. The state has so far enacted legislation to study the feasibility of enacting an exchange.
8. Nevada. Nevada has passed legislation to set up a quasi-governmental exchange governed by 10 board members. The type of contracting present in the exchange was not addressed by the legislation.
9. North Dakota. North Dakota lawmakers continue to form legislation to set up a health insurance exchange. The state has so far passed a law establishing that it will run its own exchange but has not enacted legislation to start the implementation process. State Director Janis Cheney has said listening to consumer opinion is especially important in making sure the exchange is consumer-friendly. She said the exchange will be of greatest importance to North Dakota residents in the 50-64 age bracket, the population at the greatest risk of becoming uninsured or underinsured.
10. Oregon. On June 7, Oregon lawmakers passed legislation to create an Oregon Health Insurance Exchange, which was worked on throughout 2010 by the Oregon Health Policy Board. The Oregon health insurance exchange will be a quasi-governmental active purchaser governed by nine board members. Oregon has been awarded two grants from the federal government related to the exchange: the Health Insurance Exchange Planning Grant and the Exchange Early Information Technology Innovation Grant.
11. Vermont. Vermont was one of five states to receive the "early innovator grant" to build exchange infrastructure and has received $1 million from the government to establish an exchange. In addition to establishing an exchange, Vermont plans to offer a single-payor option by 2013 and passed a bill earlier this year to begin planning for the system. The state has so far specified that the exchange will be operated by the state and will function as an active purchaser overseen by five board members.
12. Virginia. The Virginia legislature has enacted legislation establishing its intent to set up a health insurance exchange. Despite being one of the states that has opposed federal healthcare reform, the state intends to set up its exchange by the Jan. 2014 deadline.
13. Washington. Washington has enacted legislation to establish a quasi-governmental exchange governed by 11 board members. The board members will be made up of an employee benefit specialist, a health economist or actuary, a consumer advocate, a small business and experts in various subject matter areas.
14. West Virginia. On March 12, West Virginia enacted legislation to establish a quasi-governmental exchange governed by 10 board members. The bill authorizes the establishment of an exchange within the Offices of the Insurance Commissioner as a governmental agency and requires the exchange to pursue federal funds to achieve certification. If the Affordable Care Act were to be invalidated, the exchange board would issue recommendations to the legislature for amendments to the bill.
15. Wyoming. Wyoming has enacted legislation to establish the feasibility of an exchange and has since received an $800,000 grant from the federal government to plan the exchange. The Wyoming Health Benefit Exchange Steering Committee is currently working on a recommendation for the exchange.
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1. California. California was the first state to pass an exchange bill following healthcare reform in fall 2010. The state included a statement that the exchange could be an active purchaser but left specific details up to the governing board. The governing body will be comprised of five members, and the structure of the exchange is expected to be quasi-governmental.
2. Colorado. Colorado recently appointed Joan Henneberry to direct the state's health insurance exchange program, which she describes as "like Travelocity or Expedia for health insurance," according to a Chieftain report. Colorado's exchange will be structured as a quasi-governmental clearinghouse and governed by a board of 12 members.
3. Connecticut. Connecticut is currently in the process of choosing a board and staff members to oversee the development of its health insurance exchange. In Sept. 2010, the state received a one-year planning grant of $996,848 from the federal government and is now applying for $6.6 million more to pay for a second phase of development. Connecticut's exchange will be an active purchaser governed by 14 board members who represent healthcare finance and benefit administration, health economists and experts on health insurance coverage for individuals and small employers.
4. Hawaii. Hawaii's health insurance exchange will be structured as a non-profit clearinghouse, governed by 15 members until the replacement of the state's interim board on June 30, 2012. Once that board is replaced, the board of directors will include 11 members appointed by the governor, with advice and consent from the Senate. The members will include healthcare consumers, hospital trade associations and insurers.
5. Illinois. Recently approved Illinois legislation set up a 12-member legislative study committee to recommend a structure for the Illinois Health Benefits Exchange. The study committee must submit its report to the Illinois General Assembly and the governor by Sept. 30.
6. Maryland. According to Maryland Secretary of Health and Mental Hygiene Josh Sharfstein, Maryland has faced "fierce" IT challenges in developing its health insurance exchange because of the need for seamless integration between the state health program's eligibility system and the exchange. Maryland will have a quasi-governmental structure to be decided by the board of directors, a panel of nine members.
7. Mississippi. The Mississippi Insurance Department is planning to travel throughout the state in the coming weeks, speaking to employers and business owners regarding the state's proposed health insurance exchange in a series of town hall meetings. The state has so far enacted legislation to study the feasibility of enacting an exchange.
8. Nevada. Nevada has passed legislation to set up a quasi-governmental exchange governed by 10 board members. The type of contracting present in the exchange was not addressed by the legislation.
9. North Dakota. North Dakota lawmakers continue to form legislation to set up a health insurance exchange. The state has so far passed a law establishing that it will run its own exchange but has not enacted legislation to start the implementation process. State Director Janis Cheney has said listening to consumer opinion is especially important in making sure the exchange is consumer-friendly. She said the exchange will be of greatest importance to North Dakota residents in the 50-64 age bracket, the population at the greatest risk of becoming uninsured or underinsured.
10. Oregon. On June 7, Oregon lawmakers passed legislation to create an Oregon Health Insurance Exchange, which was worked on throughout 2010 by the Oregon Health Policy Board. The Oregon health insurance exchange will be a quasi-governmental active purchaser governed by nine board members. Oregon has been awarded two grants from the federal government related to the exchange: the Health Insurance Exchange Planning Grant and the Exchange Early Information Technology Innovation Grant.
11. Vermont. Vermont was one of five states to receive the "early innovator grant" to build exchange infrastructure and has received $1 million from the government to establish an exchange. In addition to establishing an exchange, Vermont plans to offer a single-payor option by 2013 and passed a bill earlier this year to begin planning for the system. The state has so far specified that the exchange will be operated by the state and will function as an active purchaser overseen by five board members.
12. Virginia. The Virginia legislature has enacted legislation establishing its intent to set up a health insurance exchange. Despite being one of the states that has opposed federal healthcare reform, the state intends to set up its exchange by the Jan. 2014 deadline.
13. Washington. Washington has enacted legislation to establish a quasi-governmental exchange governed by 11 board members. The board members will be made up of an employee benefit specialist, a health economist or actuary, a consumer advocate, a small business and experts in various subject matter areas.
14. West Virginia. On March 12, West Virginia enacted legislation to establish a quasi-governmental exchange governed by 10 board members. The bill authorizes the establishment of an exchange within the Offices of the Insurance Commissioner as a governmental agency and requires the exchange to pursue federal funds to achieve certification. If the Affordable Care Act were to be invalidated, the exchange board would issue recommendations to the legislature for amendments to the bill.
15. Wyoming. Wyoming has enacted legislation to establish the feasibility of an exchange and has since received an $800,000 grant from the federal government to plan the exchange. The Wyoming Health Benefit Exchange Steering Committee is currently working on a recommendation for the exchange.
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