Affordable Care Act: State Action Newsletter
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February 23, 2012
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Coverage Expansions Under the ACA
According to a new Kaiser Family Foundation analysis substantial variation exists across the nation in the proportion of the population that will be eligible for new insurance coverage expansions under the Affordable Care Act in 2014.
In areas of Florida, New Mexico, Texas, Louisiana and California, up to 40 percent of the non-elderly population will qualify for new coverage through Medicaid or the federal health insurance tax credits to help individuals purchase coverage in new state-based health insurance exchanges. A much smaller share of the population will be affected by ACA expansions in parts of Massachusetts, Hawaii, New York and Connecticut. Because these states already have high levels of employer-sponsored health insurance or have already implemented reforms to make coverage more affordable and accessible, only 2 percent to 4 percent of the non-elderly population will gain coverage. On average nationwide, an estimated 17 percent of the population will become newly eligible for subsidies or Medicaid.
Beginning in 2014, people with family incomes up to 138 percent of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will be eligible for Medicaid. People with family income below four times the poverty level ($92,200 for a family of four and $44,680 for a single person), purchasing coverage in health insurance exchanges will be eligible for federal tax credits to subsidize the cost of private insurance.
Interested in how individuals or your community will fare? The analysis includes two new interactive tools: enter your zip code to find out the percentage of people in your community who could become eligible for coverage or use the new calculator to see how much an individual could receive in tax credits to help pay insurance costs.
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Inside This Issue
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Final Two States Receive MLR Notification
On February 16, North Carolina and Wisconsin became the final two states to receive notification from the Department of Health and Human Services (HHS) regarding their applications for an adjustment to the medical loss ratio (MLR) standard. The MLR provision of the Affordable Care Act requires insurance companies that issue individual and small employer policies to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities beginning in 2011.
The North Carolina Department of Insurance requested that its MLR standard be set at 72 percent for 2011, 74 percent for 2012, and 76 percent for 2013. HHS partially approved an adjustment to the MLR standard for North Carolina but at rates higher than those requested by the state—75 percent in 2011 and 80 percent in 2012.
The Wisconsin Office of the Commissioner of Insurance requested that its MLR standard be set at 71 percent for 2011, 74 percent for 2012, and 77 percent for 2013. HHS denied the waiver request by Wisconsin.
In total, 17 states and Guam submitted MLR adjustment applications to HHS. Maine was the only state to have its application approved completely. Six states, Georgia, Iowa, Kentucky, Nevada, New Hampshire, and North Carolina, received partial MLR adjustments, while 10 states, Delaware, Indiana, Florida, Kansas, Louisiana, Michigan, North Dakota, Oklahoma, Texas and Wisconsin, had their applications denied.
For more information, visit NCSL’s Health Insurance Medical Loss Ratios webpage.
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States Receive Additional Funding for Exchanges
On Feb. 22, 2012, five states received their first round of Level One Establishment grants and five others received additional Level One Establishment funds from the federal Department of Health and Human Services. To date, a total of 33 states have received nearly $610 million in grants to build a state-based health insurance exchange. Level One Establishment grants are often used to continue state health exchange efforts, following completion of a number of activities under their previous exchange planning grants, which were awarded to most states in September 2010.
Level one establishment grants provide funding to states that have made some progress under their exchange planning grant. States have the opportunity to apply for multiple level one grants as they move through the planning and development process. Level Two Establishment grants are designed to help states complete their exchanges. Establishment grants are available through Dec. 31, 2014.
See the table on the right for more details. Click here for more information on exchanges.
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States that Received First Level One Establishment Grant
(Feb. 22, 2012)
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Administrator
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Amount
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Use of Award
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Arkansas
Insurance Department
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$7,665,483
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Build on its exchange planning process. Design and implement components of the state and federally facilitated exchange, determine duties for the partnership.
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Colorado
Health Benefit Exchange
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$17,951,000
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Develop operational plans. Hire operational staff and pay for consulting support to design the exchange.
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Massachusetts
Health Insurance Connector Authority
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$11,644,938
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Conduct analysis on transitions and the operational interface. Enhance the consumer experience. Launch the Health Connector 2.0 in 2014.
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New Jersey
Department of Banking and Insurance
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$7,674,130
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Continue planning efforts. Close IT gaps, gather stakeholder input. Develop a financial management plan.
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Pennsylvania
Insurance Department
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$33,832,212
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Continue research supported planning. Complete planning and develop design and operation of the exchange. Build technical infrastructure.
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States that Received Second Level One Establishment Grants
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Kentucky
Cabinet for Health and Family Services
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1st Grant: $7,670,803
2nd Grant: $57,896,810
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Support the development of an operational plan that details, planning, functions and technical design.
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Minnesota
Department of Commerce
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1st Grant: $4,168,071
2nd Grant: $26,148,929
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Build on work completed during previous grants. Design and develop IT system, consult stakeholders, and provide guidance from the advisory task force.
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Nevada
Health and Human Services Department
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1st Grant: $4,045,076
2nd Grant: $15,295,271
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Develop eligibility engine, business and IT system, and an operational plan.
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New York
State Department of Health
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1st Grant: $10,774,898
2nd Grant: $48,474,819
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Continue preparation to demonstrate operational readiness under the certification process. Establish an all-payer database to assist with quality rating.
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Tennessee
Bureau of TennCare
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1st Grant: $1,560,220
2nd Grant: $2,249,945
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Support staffing needs. Plan for health plan management system, marketing, outreach, and other administrative expenses.
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Source: HHS Exchange Establishment Grants Award List, 2012.
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Preventive Services Expanded Under Private Health Plans
On February 15, 2012, the Department of Health and Human Services released a brief estimating that about 54 million Americans have already received expanded coverage of preventive services under the Affordable Care Act (ACA). The ACA requires new insurance plans issued (or plans renewed with changes) after Sept. 23, 2010, to cover certain preventive services without cost sharing by the individual. The U.S. Preventive Services Task Force set guidelines for covering certain preventive health services for children and adults—screening for colon, cervical and breast cancers, well-child visits and immunizations, among others.
The 54 million people estimate is based on national data (see table below) from a 2011 Kaiser Family Foundation Employer Health Benefits Survey, indicating that 31 percent of workers are covered by plans affected by the new requirement, and recent Census Bureau data that 173 million Americans are enrolled in private health plans.
While some health plans previously covered these services, millions of Americans were covered by plans that did not. The HHS brief highlights examples of new services offered under the affected private insurance plans for children and adults. Under these plans children receive regular pediatrician visits, vision, hearing and obesity screenings without cost sharing. Men and women may receive screenings for cholesterol, blood pressure and obesity without copayments. Counseling services that help adults quit smoking and teach children and adults to follow a healthy diet must also be offered without copayments. Starting in August 2012, new health plans will begin covering additional health services for women with no out-of-pocket payments, such as contraception and screening for gestational diabetes.
Number of Americans Estimated to be Receiving Expanded Preventive Services Coverage
Under the Affordable Care Act, by State |
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State
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Total
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State
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Total
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Alabama
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819,000
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Montana
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166,000
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Alaska
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121,000
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Nebraska
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359,000
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Arizona
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1,056,000
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Nevada
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477,000
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Arkansas
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439,000
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New Hampshire
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279,000
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California
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6,181,000
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New Jersey
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1,694,000
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Colorado
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973,000
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New Mexico
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285,000
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Connecticut
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710,000
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New York
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3,342,000
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Delaware
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163,000
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North Carolina
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1,564,000
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District of Columbia
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107,000
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North Dakota
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130,000
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Florida
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2,841,000
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Ohio
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2,138,000
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Georgia
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1,713,000
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Oklahoma
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616,000
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Hawaii
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240,000
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Oregon
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692,000
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Idaho
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283,000
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Pennsylvania
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2,363,000
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Illinois
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2,390,000
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Rhode Island
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195,000
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Indiana
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1,160,000
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South Carolina
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755,000
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Iowa
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611,000
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South Dakota
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151,000
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Kansas
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529,000
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Tennessee
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1,044,000
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Kentucky
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732,000
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Texas
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3,836,000
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Louisiana
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719,000
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Utah
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605,000
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Maine
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226,000
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Vermont
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115,000
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Maryland
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1,153,000
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Virginia
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1,519,000
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Massachusetts
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1,324,000
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Washington
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1,239,000
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Michigan
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1,849,000
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West Virginia
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300,000
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Minnesota
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1,056,000
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Wisconsin
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1,111,000
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Mississippi
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430,000
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Wyoming
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102,000
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Missouri
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1,102,000
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TOTAL
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54,004,000
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Source: HHS, Office of the Assistant Secretary for Planning and Evaluation, Issue Brief, 2012
State Contraceptive Coverage
The recent national debate related to contraceptive coverage and the ACA brings up the question of how states have handled the issue. At least 28 states require insurers that cover prescription drugs to also provide coverage for any Food and Drug Administration (FDA)-approved contraceptive. Of these states, 21 provide for some sort of religious exemption, which varies by state. View NCSL’s chart with state-by-state information about the topic.
Announcements
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