Affordable Care Act State Action Newsletter 61

Patient Protection and Affordable Care Act: State Action Newsletter

Back to Newsletter Home Page  

August 9, 2013

Wyoming and New Jersey Study Federally Facilitated Exchanges

The Wyoming Select Committee on Health Insurance Exchanges aims to study the operation of the federally facilitated marketplace (or exchange). By law (Chapter No. CH0116), the select committee must provide recommendations on whether the state, the federal government or both should run all or certain functions, such as plan management, of the exchange. “The legislature needs data to make appropriate decisions for the citizens of the state,” said Representative Elaine Harvey (R), co-chair of the select committee.

The select committee decided to apply for a federal Level One establishment grant to examine the issues and options related to an exchange in Wyoming. The committee is, “studying which functions the state would run if Wyoming were to partner with the federal government and in what ways we can beef up the exchange,” said Harvey. Wyoming is studying other state models, particularly Arkansas’ premium assistance model, where the state would use the 100 percent federal match to purchase health plan coverage through the exchange for the Medicaid expansion population. 

The committee hopes to determine if a similar plan would be most beneficial for Wyoming’s citizens, especially for those people who churn or move in and out of exchange and Medicaid eligibility. Members are also interested in learning how competition in the exchange will be affected by such a plan.  Currently, two insurance plans are expected to participate in the federally facilitated Wyoming exchange.  A preliminary report from the select committee is due this December and a final report is due on Oct. 1, 2014, one year after the federally facilitated exchange opens for enrollment.  

New Jersey passed a measure in 2013 that established the Joint Legislative Task Force on Health Insurance Exchange Implementation. The task force will analyze and oversee the operations of the federally facilitated exchange in the state and develop recommendations for a health insurance exchange in New Jersey. It will annually report its findings and recommendations to the legislature.

Inside This Issue


California Enacts Legislation to Address Churn

The California General Assembly enacted special session Senate Bill 3, to address “churning” of people between Medicaid and the state exchange. Various circumstances can result in eligibility changes for each program, such as a change in family size or income. Efforts to reduce churn aim to continue care and provide coverage options that reduce disruptions and frustration for people who move in and out of eligibility for Medicaid or federal subsidies in the exchange.

The new law requires bridge plan products, including a Medicaid managed care plan, to be sold in the state run health insurance exchange. The act authorizes the exchange to adopt needed regulations to implement the law by early 2014. The exchange governing board approved the bridge plan in March and said contracts will be negotiated with qualified Medi-Cal Managed Care plans to develop bridge products that are affordable and focus on continuity of care. The plan also stated, “this proposal would allow individuals transitioning from Medi-Cal or Medi-Cal/CHIP coverage to Covered California to stay with the same issuer and provider network. It would also allow family members to be covered by a single issuer with the same provider network. These Bridge plans could offer very low out-of-pocket premiums for their transitioning enrollees through contracts with Covered California.” Covered California, the state’s health insurance exchange, must get federal approval of bridge plans sold in the exchange. California also expanded Medicaid under the ACA during this special session.

Maryland Exchange Rates Some of the Lowest in the U.S.

Maryland’s insurance regulator released rates for its health insurance exchange that are among the lowest in the nation. Insurance Commissioner Therese Goldsmith approved rates from nine insurance companies participating in the exchange that are up to 33 percent lower than the insurance companies’ initial proposed rates. Goldsmith cited a need to strike a balance between consumer and insurer needs as the reason for determining the lower rates.

Critics of the low rates say that the announced pricing levels are unsustainable and some insurers worry they will lose money in the exchange with the restrictions on rate increases outlined by Goldsmith.
At every level, insurance pricing in Maryland Health Connection is at the low end of the 12 other states that have released rates.  A 25-year-old non-smoker in Baltimore with the lower-end Bronze plan coverage will pay between $131 and $237 a month. A 50-year-old Marylander with a higher benefit Silver plan will pay between $260 and $269 a month. Marylanders in families with incomes between 100 percent and 400 percent of the poverty level who purchase coverage through the health insurance exchange are eligible for a tax credit to reduce the cost of coverage. The state also chose to expand Medicaid to individuals in families with incomes up to 133 percent of federal poverty guidelines. 

These relatively low rates in the state’s exchange reflect the ability of the insurance regulator to deny rate increases by insurers, many of whom proposed large hikes citing because of costs associated with ACA implementation. Thirty other states give their regulator this authority. On Aug. 2, Aetna and its subsidiary Coventry Health Care pulled out of the Maryland exchange, citing concerns with profitability after its proposed 25.4 percent rate increase was reduced by 29 percent. Although Aetna’s departure slightly reduces competition in Maryland’s exchange, state officials expect prices to remain low and competition to continue among the remaining seven insurers offering plans. Aetna has also recently pulled out of California’s and Georgia’s exchanges, and its CEO has expressed concern about the ACA rollout of exchanges.

NCSL’s Health Reform Resources from Legislative Summit

Not joining us in Atlanta for the NCSL Legislative Summit next week?  You can go online and get the latest information from national experts lined up to speak at the NCSL Health Summit, including the newly released toolkit from HHS, “Affordable Care Act Health Insurance Marketplace Outreach and Enrollment Toolkit for Elected Officials.”

To view, download or print additional meeting material from federal and state officials and public, private and non-profit sector experts, visit Health Reform Task Force online beginning Monday, Aug. 12.

2013 State Reports and Research on the ACA

Since passage of the Affordable Care Act in 2010, state research reports, data analysis and fiscal studies have helped state policymakers with decision making related to implementation of the ACA. The voracious appetite for information continues as states prepare for the implementation of major coverage provisions of the ACA.  NCSL created a web page to provide a quick link to many of these reports.
Below is a sampling of the 2013 reports; please visit NCSL’s state reports page for a full listing.

Share this: 
NCSL Summit Resources
We are the nation's most respected bipartisan organization providing states support, ideas, connections and a strong voice on Capitol Hill.

NCSL Member Toolbox


7700 East First Place
Denver, CO 80230
Tel: 303-364-7700 | Fax: 303-364-7800


444 North Capitol Street, N.W., Suite 515
Washington, D.C. 20001
Tel: 202-624-5400 | Fax: 202-737-1069

Copyright 2014 by National Conference of State Legislatures