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2010 State Implementation of Federal Health Reform

2010 State Actions to Implement Federal Health Reform 

State Actions and Federal Health Reform

Federal Health Reform

Updated: January 5, 2011

***Click here to view NCSL's NEW Federal Health Reform: State Legislative Tracking Database, inlcudes introduced legislation for the 2011 session***


On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. One week later, he also signed the Health Care and Education Reconciliation Act of 2010, together referred to as the Affordable Care Act, the act, or federal health reform.  

In response to federal health reform, many state legislatures and governors have begun setting up the infrastructure for implementing the new law. State implementation efforts continue to build as provisions take effect and timelines are developed. To date, some of the most common efforts include creating task forces or appointing officials responsible for moving forward with federal requirements and closely examining how to implement major provisions such as health insurance exchanges, insurance reforms, and Medicaid expansion. Legislators in at least 40 states have also proposed legislation to limit, alter or oppose selected state or federal actions, including single-payer provisions and mandates that would require purchase of insurance. For more information about state legislation challenging federal health reform.

States are responsible for meeting basic federal requirements outlined in the law. Some provisions of federal health reform, such as creating temporary high-risk pools, require immediate action.  The basic requirements for the high-risk pools are expected to be implemented by July 1, 2010. Other provisions, take effect six months after the act was signed and become effective September 23, 2010. Broader provisions of health reform, such as the Medicaid expansion, insurance mandates, and the health benefit exchange take effect January 1, 2014, with states planning for that date in the interim.

Table 1.1 State Legislative Implementation and Table 1.2 Executive Branch Implementation of the Affordable Care Act below offer a brief overview of state implementation efforts related to the broader aspects of federal health reform. Click on the "Other State Actions" link on the right to find state efforts on specific federal health reform provisions such as dependant coverage, high-risk pools and more.    

 

United States Map of State Actions Implementing Health Reform

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 1.1 2010 State Legislative Implementation of the Patient Protection and Affordable Care Act 

This table includes filed bills and enacted laws, where noted. As of September 27, 2010, at least 25 states have enacted or adopted legislation or taken official action to form a committee, task force, or board concerning health reform implementation.
NOTE: * indicates that Executive Action has also been taken in the state. Please see Table 1.2 Executive Branch Implementation below for more information.

State

Description of Implementation

Code

 Alabama

HJR 31 a Would establishes the Joint Legislative Task Force on Health System Reform to develop a plan for health care reform and address the state's long-term and short-term health care challenges. Failed, special session bill.

Task Force

 California*

AB 1602 Would enact the California Patient Protection and Affordable Care Act to implement reforms under the federal Patient Protection and Affordable Care Act in California. The bill contains short term implementation elements, including information regarding the California Health Benefit Exchange. Passed, signed into law by the governor,  Chapter No. 655, 9/30/2010 Full staff summary.

SB 900 Would establish the State Health Benefits Exchange within the State Health and Human Services Agency and would require the Exchange to implement specified functions imposed by the federal Patient Protection and Affordable Care Act in a consumer-friendly manner, enter into contracts with health care service plans and health insurers seeking to offer coverage in the Exchange; and provide a choice in each region of the state between five levels of coverage. Creates the State Health Benefits Exchange Fund. Passed, signed into law by the governor,  Chapter No. 659, 9/30/2010.

AB 1595 Would require the Department of Healthcare Services to establish, by June 1, 2014, eligibility for Medi-Cal benefits for any person who meets specified eligibility requirements set by federal law. Would allow the department, to the extent permitted by federal law, to phase in coverage for those individuals upon the effective date of this bill. Failed, session adjourned.

SB 1088 Would prohibit limiting the age for dependent children covered by health care service plan contracts and group health insurance policies to less than 26 years of age to conform to the federal law. Provides that no employer is required to pay the cost of coverage for dependents who are at least 23 years of age, but less than 26. Authorizes subscribers and insurers to elect to provide coverage to those dependents by contributing the premium for that coverage. Passed, signed into law by the governor,  Chapter No. 660, 9/30/2010.

SB 890 Would require health care service plans and health insurers issuing individual coverage to make certain standard benefit plan designs available to individuals with coverage choice categories. Allows a subscriber or policyholder to transfer coverage on the annual renewal date. Would create an insurance market reform commission. Relates to the minimum amount of fees and premiums spent on benefits. Relates to disclosures. Requires coverage for basic health care services. Prohibits lifetime benefit limits. Vetoed by the governor, 9/30/2010.

AB1887 Would require Managed Risk Medical Insurance Board to establish a temporary high risk pool to provide health care coverage to specified individuals who have preexisting conditions and have not been covered under creditable coverage, as defined, for the six months prior to applying for coverage in the pool. The bill would require coverage in the pool to meet specified requirements and would require premiums to be established at a standard rate for a standard population. Passed, signed into law by the governor, Chapter No. 32, 6/29/2010.

AB 2345 Would require health care service plan contracts and health insurance policies issued, amended, renewed, or delivered on or after a specified date to comply with provisions of the federal PPACA regarding coverage of, and cost-sharing for, preventive services as well as any regulations issued for this provision. Passed, signed into law by the governor,  Chapter No. 657, 9/30/2010.

SB 220 Would require certain health care service plan contracts and health insurance policies issued, amended, renewed, or delivered on or after September 23, 2010, to provide coverage, and not impose cost-sharing requirements, for certain preventive health services consistent with federal law. The bill would also require certain health care service plan contracts and health insurance policies issued, amended, renewed, or delivered on or after January 1, 2011, to provide coverage for tobacco cessation treatment that includes specified courses of treatment and medication. The bill would request the University of California, as part of the California Health Benefits Review Program, to prepare a report regarding any state savings as a result of this coverage requirement. The bill would make the coverage requirement inoperative upon a determination that it will result in the state assuming additional costs, as specified. Vetoed by the governor, 9/30/2010.

AB 2244 Would prohibit the exclusion or limitation of coverage for children due to any pre-existing condition. Would require plans and insurers offering coverage in the individual market to offer coverage for a child. Would prescribe limits on the rates that may be imposed. Would require plans and insurers to apply standard risk rates to such coverage. If a plan does not cover children, it will be prohibited from offering new individual policies. Passed, signed into law by the governor,  Chapter No. 656, 9/30/2010.

AB 2287 Would require the California Health and Human Services Agency to direct the appropriate departments within the agency to apply for federal community transformation grants under the ACA. Such opportunities include local government agencies, local public health departments, school districts, state and local nonprofit organizations, and Indian tribes. Failed, session adjourned.

AB 2354 Would require the State Department of Public Health to assess grants under the federal Patient Protection and Affordable Care Act for funding opportunities related to the use of promotoras (community health workers) in medically underserved communities and to report on the assessment to the fiscal and health policy committees of the Legislature with recommendations for attaining and maximizing federal funding. Failed, session adjourned.

AB 1825 Would require health insurance policies issued, amended, or renewed on or after and before specified dates, to provide coverage for maternity services. Would require policies issued, amended, and renewed after a specified date to provide such coverage consistent with the federal Patient Protection and Affordable Care Act. Would authorize certain policies to include a specified exclusionary period on maternity services. Requires the insurer to provide exclusionary information at the time of policy solicitation. Vetoed by the governor, 9/30/2010.

The California Legislative Analyst's Office (LAO) prepared a report on The Patient Protection and Affordable Care Act: An Overview of Its Potential Impact on State Health Programs and a report on Moving Forward with Eligibility and Enrollment Process Improvements.

Broad
Exchanges
Dependents
Medicaid
Insurance Reform
High-Risk Pools
Funding
Prevention

 Connecticut*

Public Act 09-148 In 2009, Connecticut passed the SustiNet plan creating a framework for comprehensive health reform and the SustiNet Health Partnership Board of Directors. The board was charged with making implementation recommendations for health reform in the state and for issuing recommendations for implementation upon the passage federal health reform. The board's full report of recommendations of federal health reform implementation is expected to be released in May 2010. Click here to view SustiNet's most recent meeting minutes.

Broad
 

 Delaware

The Delaware Health Care Commission is the body charged with overseeing Delaware's response to and implementation of federal health reform.  The Secretary of Health & Social Services, a member of the commission, is leading the effort.  The commission's activities will be supported by an interagency staff workgroup. It is expected that the Commission will empanel working groups of pertinent public and private stakeholders to assist in implementation policy discussions. Title 16, chapter 99 of the Delaware code created the Delaware Health Care Commission in 1990. Since May 2010, the committee requested that federal health reform implementation be added to each agenda for committee meetings, to view meeting agendas and minutes, click here.

Commission
Broad

 District of      Columbia*

B 791 Would establish a Health Care Reform Implementation Advisory Board for the purposes of facilitating interagency, cabinet-level leadership in the planning, policymaking, program development, and budgeting that is necessary to properly implement PPACA. Failed, session adjourned.

Broad
Advisory Board

 Illinois*

SB 3047 Would amend the Health Care Justice Act and change its title to the Health Care Justice Implementation Act. Would create a Health Care Justice Implementation Task Force to monitor implementation federal health reform, to report on additional reforms, and to review current programs. Amendatorily vetoed by the Governor, 7/30/2010.

HB 5887 Provides that if the federal government enacts or implements any provision that would require states to operate a health insurance exchange that includes a public or state-run plan or if the federal government operates a nationally based health insurance exchange with a public plan option and a mechanism exists for individual states to opt out of the public option, then the State shall exercise the right to opt out of such a public plan. To House Committee on Rules, 2/10/2010.

Broad
Task Force
Exchange

 Iowa

2009 Iowa Acts, S.F. 389, §1 created the Iowa Legislative Health Care Coverage Commission to develop an Iowa health care reform strategic plan. The plan will include a review and analyze options for health care coverage of Iowa residents and provide prioritized recommendations. 2009 recommendations include expanding the existing IowaCare program, develop a seamless system, design an exchange, and increase funding for technological capacities, among others. In 2010, introduced legislation created the Iowa Insurance Information Exchange. The commissioner of insurance and the commission will work together to develop a plan of operation for the exchange within 180 days of July 1, 2010. The commission will hold three meetings from June to October 2010 to complete their duties, using a workgroup format that was developed in 2009 and collaborate with the Department of Human Services, the Department of Public Health, and the Insurance Commissioner to incorporate changes that will occur as part of federal health reform. Click here to view the interim commission's web site.

SF 2356 Would provide options for health care coverage by creating a premium assistance program study, making changes to the Iowacare program, and creating a state health insurance information exchange. Signed into law by the Governor, 4/14/2010.

Commission
Broad
HIT

 Louisiana

HB 903 Relative to the Louisiana Health Plan, would provide for compliance with federal law for expanded coverage. The board, with the approval of the commissioner, may establish, provide for, administer, and contract to provide coverage for a health plan to offer eligible individuals and families the ability to purchase or enroll in a program established under federal law that provides expanded coverage for state high-risk pools. Failed, session adjourned. 

Broad
High-Risk Pools

 Maine*

The Maine Legislature created a Joint Order establishing the Joint Select Committee on Health Reform Opportunities and Implementation. The joint committee will be a bi-partisan group of 17 legislators appointed by the speaker of the House and the president of the Senate. The committee is responsible for studying the federal law and determining the role of the state in implementing health reform and how it will affect current state programs and laws such as MaineCare. The committee is also responsible for consulting with other stakeholders including the Governor's Office of Health Policy and the Department of Health and Human Services. The committee must submit a report to the legislature by November 3, 2010. Click here to visit the Joint Select Committee's web site.

Broad 
Exchanges
 

 Maryland*

SB 57 Clarifies that certain provisions of the federal Patient Protection and Affordable Care Act shall apply to all health insurers. Including, prohibiting health plans from denying coverage to children with pre-existing conditions, banning insurers from dropping health coverage when they get sick, requiring plans to allow young people up to the age of 26 to remain on their parents' plan, and banning lifetime caps on coverage. Signed into law by the governor, Chapter No. 17, 4/13/2010.

Insurance
High-Risk Pools
Dependents Coverage

 Massachusetts

SB 2585 Among other provisions, the bill would establish a small group wellness incentive program, and among other requirements, a small group is eligible if able to receive federal health care tax credits under the ACA. Also requires the commissioner of insurance to apply for and accept all available federal funding in the ACA. Signed by governor, 8/10/2010.

Insurance

 Michigan

HB 6240  Would require a health benefit plan that provides dependent coverage to permit continuation until a child attains age 26. Would provide that  the insurer can not deny a child under a specified age access to his or her parent's plan and shall not impose any preexisting condition exclusion or limitation; relates to notification of health benefit plan premium increases; requires incurred losses, claims, and loss adjustment expense or change reporting by insurers; require rebates. Failed, session adjourned. 

Insurance
Dependents

 Minnesota

Laws 2010, First Special Session, Chapter 1, Article 22, Section 4 The legislature authorized the Governor to convene the Health Care Reform Task Force. The task force will advise and assist the governor and the legislature regarding state implementation of the new federal health reform law. The task force will consist of two legislators from the house, two legislators from the Senate, two representatives appointed by the governor to represent the governor and state agencies, three people appointed by the governor who have demonstrated health leadership, five people appointed by the governor who have demonstrated expertise in health financing, access, and quality. The Department of Health, the Department of Human Services, and the Department of Commerce will provide staff support to the task force. The task force will produce a report by December 15, 2010 with recommendations for state law, program changes and implementation.
In addition, the bill includes a section on the American Health Benefit Exchange, it requires the commissioners of commerce, health, and human services to jointly or separately apply to planning grants related to the creation of exchanges. The commissioners must also provide a report to the Legislature by December 15, 2010 that analyzes the pros and cons of the state creating a health benefit exchange as outlined in the Affordable Care Act. Enacted, 5/21/2010. 
Click here to view the governor's appointments.

HB 3709 Would require the creation of Health Insurance Exchanges to comply with federal laws. Would make conforming and other changes related to federal health care reform and provide funding for health care subsidies. Would establish accountable care organizations and a publicly administered health plan; expands eligibility for medical assistance and would repeal the MinnesotaCare program and related taxes. Failed, session adjourned.

SF 3296 Would make conforming and other changes related to federal health care reform, including providing funding for health care subsidies, establishing accountable care organizations, establishing a publicly administered health plan and expanding eligibility for medical assistance. Would eliminate the MinnesotaCare Program. Failed, session adjourned.

HB 3778 and SF 3375 Would require health plans issued or renewed to cover a resident of Minnesota to comply with the provisions in PPACA relating to coverage of routine patient costs incurred in connection with clinical trials. Failed, session adjourned.

Task Force
Broad
Exchanges
Insurance
 

 Mississippi

SB 2554 Would create the Health Insurance Exchange Study Committee to conduct a study of health insurance exchanges as proposed at the federal level and to make implementation recommendations. Signed into law by the governor, Chapter No. 527, 6/1/2010. 

Committee
Exchanges

 Montana

SJR 35 Created a 2009 and 2010 interim committee within the Children, Families, Health and Human Services Interim Committee to study federal and state efforts related to health care reform and to make recommendations for state-level initiatives to be considered by the 62nd Montana Legislature. For committee updates, click here.

Broad
Committee

 Nebraska

LR 467 Would allow for an interim study to conduct research and provide recommendations for implementing the federal Patient Protection and Affordable Care Act. Membership of the select committee includes Senators from the Nebraska Health and Human Services Committee, Appropriations Committee, and Banking, Commerce and Insurance Committee. The first select committee hearing is scheduled for August 2010, a final report is due to the legislture on or before December 31, 2010. Failed, session adjourned.

LR 372 Would designate the Health and Human Services Committee of the legislature to conduct an interim study to study the potential effect of national health care reform proposals on Nebraska and analyze policy options for responding to and implementing health care reform measures. Will also include stakeholder input. Required to report findings and recommendations to Legislative Council or legislature. Failed, session adjourned.

Broad

 New Hampshire

SB 455 Authorizes the Insurance Commissioner to implement the insurance reforms required under federal law; revises the laws regarding independent coverage to conform to federal law. Passed, signed into law by governor, Chapter No. 243, 7/1/2010.

SB 505 Would establish a commission on health care cost containment to make recommendations on containing costs and improving quality. The commission will take PPACA and Reconciliation Act into account when developing recommendations. Passed, signed by Governor,  Chapter No. 224. 6/28/2010.

Insurance
Commission

 New Jersey

SB 2239 and AB 3202 Would establish the New Jersey Health Care Reform Implementation Council as the formal entity to plan for and coordinate the implementation of health care reform in accordance with PPACA. Senate Bill: Amended on Senate floor, 11/22/2010. Assembly Bill: Referred to Assembly Health and Senior Services Committee, 9/16/2010.

Broad
Commission

 New Mexico*

SJM 1 Creates the health care reform working group. The superintendent of insurance of the Public Regulation Commission will convene a health care reform working group to make recommendations to the Governor and the Legislature regarding implementation and supplementation of federal and state health care reform measures. This group was formed during the legislative session while federal health reform was being considered, before the health law passed. The Task Force is made up of the Superintendent of Insurance of the NM Public Regulation Commission, the Department of Health, Human Services Department, the Legislative Finance Committee, the Legislative Health and Human Services Committee, the Insurance Division of the Public Regulation Commission, the New Mexico Medical Insurance Pool and the New Mexico Insurance Alliance. Adopted

In April 2010 the Legislature’s leadership committee, the Legislative Council, instructed the interim Legislative Health and Human Services Committee, which is a regular interim legislative committee that meets each year,  to include analysis of PPACA throughout the interim (through November 2010) in its interim work plan. The Legislative Health and Human Services Committee itself was created as a permanent interim committee of the legislature in 1989 pursuant to Section 2-13-1 NMSA 1978; its 2010 work plan specifying PPACA analysis was not created pursuant to legislation.

 The Legislative Finance Committee has placed PPACA analysis on many of its interim agendas for 2010.The Legislative Finance Committee is a permanent interim committee of the legislature created pursuant to Section 2-5-1 NMSA 1978 in 1953; its 2010 work plan was not created pursuant to legislation.

Broad
Commission

 New York*

SB 7871 Would establish a temporary task force to examine, evaluate, and make recommendations concerning the effects on the state of and the means, methods, and procedures of implementing PPACA and the Reconciliation Act. Recommendations will be submitted to the governor and to the legislature on or before March 31, 2011. Report can also include legislative proposals to implement recommendations. In Senate Committee on Finance, 5/19/2010.

Broad
Task Force

 North Carolina

SB 897 Included in the session appropriations bill is section 24.2.(a) which would amend G.S. 58-2-40 by adding a new subdivision to administer and enforce the provisions of the federal Patient Protection and Affordable Care Act and the provisions of the Health Care and Education Reconciliation Act of 2010 to the extent that the provisions apply to persons subject to the Commissioner's jurisdiction and to the extent that the provisions are not under the exclusive jurisdiction of any federal agency. In addition, section 24.2 requires The Department of Insurance to apply for federal funds that are available through the Affordable Care Act to support 13 positions within the Department to implement this section. Passed, signed into law by governor, Session Law No. 2010-31, 6/30/2010.

Insurance

 North Dakota

The Legislative Management committee created the Interim Industry, Business, and Labor committee. The committee was beginning to examine the health care reform legislation as part of its study of the factors impacting the cost of health insurance. The committee’s role is and will be to receive information from state agencies and other interested parties, including health care providers, insurance companies, business groups, advocacy groups, and national experts, which relates to the impact on the state of the federal health care reform legislation. 

Broad
Committee
Insurance

 Ohio*

Ohio's Health Care Reform Stakeholder Forum includes the Ohio Health Care Coverage and Quality Council which was established by the Ohio General Assembly in July 2009 following its initial creation by an Executive Order from Governor Ted Strickland. The Ohio Health Care Coverage and Quality Council continues a public-private partnership designed to improve the coverage, cost, and quality of Ohio’s health insurance and health care system. The Council consists of over 30 members from the provider, payer, consumer, and policy communities. State agencies responsible for heath care and insurance delivery and oversight are represented, as is the Ohio General Assembly. The Council encourages and provides regular opportunities for public comment.

Broad

 Oregon

 In 2009, Oregon enacted HB 2009 which established the Oregon Health Care Authority in the executive branch. The authority is charged with health care reform and the bill includes many provisions similar to or that will be enhanced by the federal health reform law.

Broad

 Pennsylvania*

HB 2462 Would establish the Health Insurance Reform Implementation Authority and the Health Insurance Reform Implementation Authority Fund. Would eliminate duplication between the Department of Public Welfare and the Insurance department, making the children's health insurance program, the adult basic coverage insurance program, the medical assistance program, the high risk pool, the American Health Benefits Exchange, and Small Business Health Operations program more efficient. Failed, session adjourned.

HB 2759 Would enact the Commonwealth Access to Health Insurance Reform Act. Would establishes the Pennsylvania Health Insurance Reform Implementation Authority,  createing a Health Insurance Exchange for the small employer group and the individual market. Would authorize a surcharge on health benefit plans to pay for the Health Insurance Exchange. Would impose duties on the Insurance Department, Department of Health and the Office of Administration. Failed, session adjourned.

HB 2514 Would create the Pennsylvania health insurance plan for uninsurable individuals, which will be governed by a board. The board will establish a plan of operations and submit it to the commissioner. Individuals will be eligible for the plan if they have been covered for 6 months before applying for the plan and have a pre-existing condition at the time of the application. Dependents shall also be covered under an eligible parent. The plan shall establish premium rates for plan coverage consistent with the PPACA, and rates and schedules shall be submitted to the commissioner for approval. The act shall expire at the end of the fiscal year in which the American Health Benefit Exchange will commence. Failed, session adjourned.

Insurance
Exhange
High-Risk Pools
 

 Rhode Island*

SB 3021 Would create a 17-member special Senate commission to study cost containment, efficiency, and transparency in the delivery of quality patient care and access by hospitals. The commission is appointed to study cost containment, efficiency, and rate reimbursements. At its own discretion, the commission may also study the development and establishment of a state-based insurance exchange. The members shall meet regularly beginning September 15, 2010 through December 31, 2011 and present its findings and recommendations on the exchanges to the clerk of the Senate no later than May 31, 2011.  Adopted, Resolution No. 2010-341,  6/10/2010.

SB 2552 Amended to meet all federal health reform insurance requirements. Would create the Rhode Island Health Reform Act of 2010. Would establish the HealthRIght. Authority through which all public and private purchases of insurance or health care services will be transaction for employers and individuals. Would establish a health insurance from which residents can purchase insurance coverage from a range of insurers. Would also establish an insurance product which will serve as the basic plan which includes setting and limiting co-pays and deductibles for the plan. Senate Committee on Health and Human Services recommends holding the measure for further study. Failed, session adjourned.

Broad
Insurance
 

 South Dakota

The state has a four person legislative panel which consists of two Democrats and two Republicans that keep their caucuses informed about what the governor's office is doing as far as implementation of the federal law.

Broad

 Texas

The Texas House created a House Select Committee on Federal Legislation, with a focus on implementing federal health reform.

Broad
Committee

 Utah

HB 67 Would require all state agencies, including the Governor’s office, to make a presentation to lawmakers before making any decisions about how to implement it in Utah.  It would also prohibit state residents from being required to purchase health insurance, as mandated in the federal law. Enacted, Chapter No. 51, 4/7/2010.

Broad

 Vermont*

Act No. 128 (2010 SB 88) A consultant is required to produce at least three health system designs and implementation plans. The design options and implementation plans must meet the goal of providing universal access to health care through a public or private single-payer or multipayer system. In creating the design options, the consultant must always review and consider the Patient Protection and Affordable Care Act, ERISA, Medicare, Medicaid and CHIP. Each design option will also propose a single system of health care which maximizes federal funds to support the system, including a proposal to participate in a federal insurance exchange established in the federal health reform law. The consultant has until February 1, 2011 to complete the health system design and implementation plan. Enacted, became law without governor signature, 5/27/2010.

Exchanges
Funding
Broad

 Washington*


 

SB 6444 (Section 694) The legislature passed a budget proviso on April 12, 2010 establishing a Joint Select Committee on Health Care Reform. The joint legislative select committee on health reform implementation shall be co-chaired by the chairs of the health committees of the senate and the house of representatives, and leadership of the two largest caucuses in the senate and the house of representatives shall each appoint two additional legislators to serve on the committee. The co-chairs may direct the formation of advisory committees, if desired, to focus on specific topic areas, such as insurance regulation, access and expansion of public and private programs, and workforce issues, and may invite interested stakeholders and additional experts to advise the committee. All participation in the joint select committee and any advisory committees is without compensation. Click here for more information on the Joint Legislative Select Committee on Health Reform Implementation.

Broad

 West Virginia

The Governor's Office of Health Enhancement and Lifestyle Planning (GOHELP) was created by SB 414, which was effective from passage August 26, 2009, or 90 days from passage during the 2009 Legislative Session. The Governor’s Office of Health Enhancement and Lifestyle Planning was created last year to coordinate health care reform by the Legislature.   Click here to visit the Governor's Office of Health Enhancement and Lifestyle Planning website.

Broad
 

 Wisconsin*

The Joint Legislative Council established the special committee on health care reform implementation in May 2010. The special committee  is directed to make recommendations on statute and administrative rules that need to change in order to implement federal health reform. The committee will also study the new law and its affect on the state's insurance market, coverage of the uninsured, preventive care, taxation, quality improvement, and the health workforce. The Committee began meeting in August 2010.  Click here to view the committee's website. Included in the special committee web site are meeting minutes from previous meetings.

Broad
Committee

 NOTE: * indicates that Executive Action has also been taken in the state. Please see Table 1.2 Executive Branch Implementation below for more information.

Table 1.2 Executive Branch Implementation of the Patient Protection and Affordable Care Act

In most states, governors issue "executive orders" which do not require legislative action. These orders can initiate action among state agencies, such as establishing a board, task force or commission. Executive orders can not alter laws, programs specified by statute, or appropriate money. As of September 27, 2010, at least 14 governors have issued executive orders to begin the process of health reform implementation.
NOTE: * indicates that Legislative Action has also been taken in the state. Please see Table 1.1 State Legislative Implementation above for more information.

State

Description of Implementation

Code                     

California*           

Governor Arnold Scwarzenegger formed the Health Reform Task Force to implement key short and long-term reform provisions and programs. The governor also submitted a letter to the secretary of the U.S. Health and Human Services seeking federal funding for coverage expansions.

On July 7, 2010, Governor Arnold Schwarzenegger announced that California has submitted a proposal to Health and Human Services Secretary Kathleen Sebelius regarding the state’s medical insurance rate review and data collection activities, and report rate increase patterns to the federal government.

Task Force
Broad
Insurance                

Colorado

Governor Bill Ritter issued Executive Order B-2010-006 creating the Interagency Health Reform Implementation Board. The Executive Order also named a director who will oversee 10 state agencies responsible for implementing health reform and creates a new inter-agency task force. The board will provide quarterly reports to the governor on the status of implementation.In addition, they will develop a strategic plan for implementation, outlining agency coordination efforts. 

The Health Reform Implementation Board is hosting community health insurance exchange forums. The meetings review options in implementing the health insurance exchange and they are open to the public, meetings are held in various locations across the state.

Task Force
Appointed Official
Broad
Exchange

Connecticut*

On June 21, 2010 the Center for Medicaid and Medicare Services approved Connecticut's plan amendment to expand Medicaid to low-income uninsured childless adults. Connecticut is the first state that will enroll individuals whose annual income is up to 56 percent of the FPL or $6,650 per year for an individual in 2010 under the Affordable Care Act. Click here to view the HHS news release.

Governor M. Jodi Rell issued Executive Order No. 43 creating the Health Care Reform Cabinet, which is to be filled with commissioners from various state health agencies. The cabinet will develop strategies to implement federal health reform while building upon existing state health programs. The cabinet is also responsible for pursuing federal money available for health reform implementation. The cabinet is also responsible for informing state residents of the health options now available as a result of the new law, including information on how this law affects access, high risk pools, exchanges and insurance market reforms. The cabinet will also ensure that the Department of Public Health creates a website that provides state residents with information about federal health reform. In May the Health Care Reform Cabinet released a progress report.

Medicaid
Cabinet
Broad
Exchanges
Insurance Reform
High Risk Pools
Funding

District of Columbia*

The District of Columbia received approval from the Centers for Medicare and Medicaid Services to expand the eligibility for their Medicaid program to low-income childless adults. As of July 1st, 2010 the District will be able to move 35,000 individuals from the D.C. Healthcare Alliance medical plan, funded by the city, to Medicaid.

Medicaid

 Illinois*

Governor Pat Quinn issued Executive Order 10-12 creating the Illinois Health Reform Implementation Council, which is to be made up of the directors of various state agencies. The council is responsible for making recommendations to the Governor on how the Affordable Care Act should initially be implemented. These recommendations will focus on reforming Medicaid, increasing the health care workforce, pilot programs, insurance reforms, electronic medical records, and identifying possible funding. The council will submit its first report to Governor Quinn on December 31, 2010.

Council
Broad
Medicaid
Exchanges
Funding
Insurance 

Maine *

Governor John Baldacci issued an Executive Order Implementing National Health Reform in Maine (Executive Order 12) establishing the Health Reform Implementation Steering Committee. The steering committee will work in coordination with the Governor's Office of Health Policy and Finance (GOHPF) and key state agencies to implement national health reform. The executive order determines that the GOHPF with serve as the liaison between the state and federal government while working in coordination with local and tribal governments. The steering committee will also ensure coordination and information sharing with the Legislative Joint Select Committee on Health Reform. The steering committee and GOHPF will develop plans to implement provisions of health reform, including high risk pools, the state health exchange, and an overall plan with a timeline for implementation.

Committee
Broad
Exchange
High Risk Pools
Funding

Maryland*

Governor Martin O'Malley issued Executive Order 01.01.2010.07 establishing the Maryland Health Care Reform Coordinating Council. The council must submit a review of the federal health reform by July 15, 2010. The review will include a description of health reform provisions, a timeline for the implementation of health reform components, financial models, and an approach to evaluate policy options. By January 1, 2011, the council is required to submit a comprehensive document with policy recommendations and implementation strategies. Maryland's council includes four state legislators.
Click here to view Maryland's health reform website.

Council
Broad

Michigan

Governor Jennifer Granholm issued Executive Order No. 2010-4, which established a Health Insurance Reform Coordinating Council to identify steps for implementing the Patient Protection and Affordable Health Care Act.

Council
Broad

Nevada

The Health Care Reform Policy Group was created by the Department of Health and Human Services. The group will have information posted to the Department of Health and Human Services web site by June 10, 2010. In addition, the Health Care Reform Implementation Working Group is led by the Administrator of the Division of Health Care Financing and Policy and focuses on how the new law will affect the state's Medicaid policies.

Broad
Medicaid

New Mexico*

Governor Bill Richardson issued Executive Order 2010-012 establishing the New Mexico Health Care Reform leadership team for the implementation of national health reform. The leadership team is responsible for developing a strategic plan for implementing health reform by July 1, 2010. The leadership team is responsible for the oversight of the plan and the coordination between state agencies. The executive order states that the Human Services Department has the primary responsibility for providing administrative staff to the leadership team. The strategic plan should include any necessary data, an analysis of how the legislation will affect the state budget, identify federal funding sources, an analysis of how existing state programs will change, and a timeline for implementation. In July 2010, the leadership team released the health reform implementation strategic plan, which was accepted by Governor Richardson. Click here to view the plan.

Council
Broad

New York*

Governor David Paterson established the Cabinet to Implement Federal Health Care Reform in New York. The cabinet will advise and make recommendations to the governor on all aspects of federal health reform. The will also develop a strategic plan to guide implementation. State agencies will make up the health reform cabinet and an advisory group will also be appointed to assist and advise the cabinet on reform provisions and include stakeholder and public engagement. On August 31, 2010, the governor named 37 organizations to the Health Care Reform Advisory Committee. Click here to view more details, including the organizations named to the governor's advisory cabinet.

Broad

Ohio*

In August 2009, the state's executive branch created the Ohio Health Care Reform Stakeholder Forum. This is an interagency group with representation from the Governor’s Office and Cabinet Agencies, including the Department of Insurance, the Health Care Coverage and Quality Council, Department of Health, Department of Mental Health, Department of Aging, Department of Alcohol and Drug Addiction Services, Department of Job & Family Services, Department of Administrative Services, Department of Developmental Disabilities, and the Board of Regents. As Ohio moves forward in planning and implementation they plan to use existing external stakeholder groups and/or ad hoc committees for assistance. The state currently has a website that contains health reform implementation information and minutes from the Forum meetings, click here to view the Ohio Health Reform website.

Broad

Pennsylvania*

Governor Edward Rendell issued Executive Order 2010-02 creating the Commonwealth Health Care Reform Implementation Committee and the Commonwealth Health Care Reform Advisory Committee. The implementation committee is responsible for designing models for high-risk pools, exchanges, and identifying technical assistance. They will prepare a strategic plan for implementation and identify legislative action and draft legislation necessary to enable full implementation. They will also create inter-agency teams, if needed. The implementation committee and the advisory committee will work together to implement health reform. The advisory committee will include eight legislators. The advisory committee will provide feedback to the strategic plan created by the implementation committee and identify best practice models and advise the implementation committee on the design of models pertaining to high-risk pools, exchanges, insurance, and technical assistance.

Committee
Broad
High-Risk Pools
Exchanges
Insurance

Rhode Island*

Lt. Gov. Elizabeth H. Roberts announced the formation of the "Healthy RI Implementation Task Force" in a meeting on May 25, 2010. Click here for the Healthy Rhode Island Task Force Report.

Task Force

Vermont*

Governor Jim Douglas issued an Executive Order creating the Governor's Health Care Cabinet on October 14, 2009. This executive order was issued before the passage of federal health reform legislation, but it was created in anticipation of federal health reform. The Health Care Cabinet is responsible for recommending a coordinated and strategic response by the State to legislative health reform initiatives at the state and federal levels.

Cabinet
Broad

Virginia

The Virginia Secretary of Health and Human Resources, Dr. Bill Hazel announced the establishment of the Health Care Reform Initiative on May 14, 2010. The Health Care Reform Initiative will manage activities related to federal health care reform.  The Health Care Reform Initiative will serve as the liaison between the governor's office, agencies and entities affected by health care reform, lead development of the required Health Insurance Exchange and identify and coordinate grants to fund health care reform. The initiative will make findings and recommendations addressing Medicaid reform, insurance reform, and health care delivery reform. The initiative will develop an advisory group workgroup of stakeholders and interested parties to provide input and advice. The initiative will also submit recommendations to the governor by September 30, 2010. Governor Bob McDonnell appointed the members of the advisory council in August 2010, click here to view the members.

Broad
Medicaid
Exchanges
Insurance

Washington*

Governor Christine Gregoire issued Executive Order 10-01, which created the Health Care Cabinet. The cabinet is responsible for providing leadership and accountability for implementation of state and federal health reform. The cabinet is required to submit a work plan by August 1, 2010, outlining structures and processes needed by state agencies for implementation. The plan will also include specific action steps, timelines and lead responsibility of implementation. Click here to view a list of cabinet members. Click here for information on the cabinet's meetings.

Cabinet
Broad

Wisconsin*

Governor Jim Doyle issued Executive Order #312, which created the Office of Health Care Reform. The Office of Health Care Reform is led by the secretary of the Department of Health Services and the commissioner of insurance. The office is responsible for developing a plan that uses national health care reform to build on the state's existing programs. The office is also to provide transparent access to information, assess insurance markets reforms to prepare for national health reform, develop a plan to pursue federal funding for implementation, and create a health insurance purchasing exchange.
Click here to view Wisconsin's health reform website.

Office
Broad
Exchange
Insurance Reform
Funding

Wyoming

Governor Dave Freudenthal has convened a State Agency Leadership Team to determine how the health reform acts affect state programs and the people they serve. The team will draft a short-term work plan by January 1, 2011, describing actions that need to be taken for implementation. The team is composed of directors of state agencies whose programs will be affected by health reform.

Broad

Virgin Islands

Governor John P. de Jongh, Jr. issued Executive Order No. 449-2010 creating the Virgin Islands Health Reform Implementation Task Force. The task force is responsible for analyzing the Patient Protection and Affordable Care Act and offering recommendations on its implementation. The task force is responsible for providing the governor with quarterly reports, the first of which must be submitted within 60 days of the establishment of the task force (established June 2010). The Task Force is also responsible for creating a Master Implementation Plan, which must be submitted within 180 days of the task force's first meeting. Click here for more information.

 

 NOTE: * indicates that Legislative Action has also been taken in the state. Please see Table 1.1 State Legislative Implementation above for more information.

Other State Actions

 

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