This morning the U.S. Supreme court determined the Affordable Care Act (ACA), or “ObamaCare,” to be constitutional in National Federation of Independent Business v. Sebelius. The most widely discussed consequence of this ruling is that the federal government is allowed to require all Americans buy health insurance by 2014. One of the most significant aspects of this ruling for state governments is that the establishment of state-level health insurance exchanges will remain in place. Given other aspects of the ruling in regards to Medicaid, Rep. Phil Gingrey, R-Georgia, argues that more people will opt in to the exchanges to receive subsidized plans instead of receiving Medicaid, according to CNN.
State-level health insurance exchange implementation will come under increased scrutiny over the coming months following the ruling. This is especially true in swing states, which remain a focal point in the ongoing the Presidential campaign, especially because some states fought establishing exchanges until the Supreme Court ruled on the case.
Rather than reinvent the wheel, I’m going to excerpt research on where swing states stand in implementing the exchanges from an excellent Associated Press article published this morning. I determined the 11 swing, or toss up, states from Real Clear Politics’ electoral map. Information about the remaining 39 states is also detailed in the aforementioned Associated Press article.
| State | Electoral College Votes | Number of Uninsured | Percentage of Population Uninsured | Progress of Implementation |
|---|---|---|---|---|
| Colorado | 9 | 656,000 | 13 | Colorado lawmakers passed legislation in 2011 to set up health insurance exchanges, and a commission is in the process of implementing them. The exchanges are set to start October 2013. |
| Florida | 29 | 3,850,000 | 21 | Republican Gov. Rick Scott ordered the state not to accept federal money for implementing the health care law after he took office last year. Florida has rejected or declined to pursue more than $106 million and has returned $4.5 million. The state has its own health insurance exchanges, mainly for small businesses but without an individual mandate. The state has not implemented an exchange that would meet the requirements of the federal law. |
| Iowa | 6 | 366,000 | 12 | The state does not have a law establishing a health insurance exchange, and Republican Gov. Terry Branstad has said Iowa will create a state-based exchange only if the law is upheld. The Republican House Majority leader says the state has already enacted several pieces of the law, including a website that helps residents find insurance, but the state has yet to comply with other requirements. |
| Michigan | 16 | 1,270,000 | 13 | The Department of Licensing and Regulatory Affairs has been working to set up a health insurance exchange but has had limited success because House Republicans refuse to let it use $9.8 million in federal planning dollars. Because of looming federal deadlines to have an exchange in place, state officials are planning for a state-run exchange while also talking to federal officials about a possible partnership on a federal exchange where the state handles just some responsibilities, such as customer service. |
| Missouri | 10 | 835,000 | 14 | Missouri received an initial planning grant but has not implemented a health insurance exchange because of opposition to it by some Republican state senators. |
| Nevada | 6 | 563,000 | 21 | The Nevada Legislature in 2011 passed a bill implementing the Silver State Health Insurance Exchange and creating a seven-member board to oversee it. Republican Gov. Brian Sandoval opposed the federal health care law as a candidate. He also allowed a private attorney appointed by former Gov. Jim Gibbons to continue representing Nevada in the lawsuit filed by more than two dozen states challenging the law. State officials estimate the Affordable Care Act would cost Nevada $575 million in the first five years as more people become eligible for Medicaid. |
| New Hampshire | 4 | 134,000 | 10 | New Hampshire currently has laws that echo portions of the Affordable Care Act, such as allowing dependent unmarried residents to remain on their parent’s health care insurance until age 26. Last year, state legislators passed laws that said residents cannot be required to obtain health insurance or be fined for not being covered. They also established a state oversight committee that must give its OK before the federal law is implemented. Democratic Gov. John Lynch’s office said it has done some work on implementing aspects of the Affordable Care Act, but has put plans on hold until the U.S. Supreme Court makes its ruling. |
| North Carolina | 15 | 1,570,000 | 17 | Legislation aimed at prohibiting the mandate for individuals to buy health insurance was the first item introduced after Republicans took over control of by North Carolina’s General Assembly last year. Lawmakers haven’t been able to overcome Democratic Gov. Beverly Perdue’s veto of their bill. But work to design health care exchanges has stalled since last summer. |
| Ohio | 18 | 1,500,000 | 14 | Ohio has not moved to create a health care exchange but is evaluating its options. It received a $1 million federal exchange planning grant in 2010. Republican Gov. John Kasich’s administration has taken advantage of some parts of the new law to expand coordinated care and propose changes to Medicaid eligibility. Democrats have unsuccessfully pushed bills in the Legislature to set up a state-run exchange. But Lt. Gov. Mary Taylor, who is also Ohio’s insurance director, frequently criticizes the overhaul and says it’s premature to plan for an exchange without further clarification from the federal government. |
| Virginia | 13 | 1,100,000 | 14 | Virginia has expressed its intent to create a health care exchange, but Republican Gov. Bob McDonnell has not acted on recommendations made by a gubernatorial advisory council. Virginia filed its own lawsuit challenging the health care law, but lost in federal appeals court. |
| Wisconsin | 10 | 526,000 | 9 | Wisconsin has not begun setting up its health insurance exchange. Work on that was put on hold in January by Republican Gov. Scott Walker, who wanted to await the Supreme Court’s decision. |
Source: Where states stand on implementing health care law, Associated Press, June 28, 2012. http://hosted.ap.org/dynamic/stories/U/US_HEALTH_CARE_STATES_GLANCE.