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State Actions to Implement the Health Benefit

State Actions to Address Health Insurance Exchanges

Richard Cauchi, Health Program 4/7/2015

2015 Deadlines Extended | Court Steps | State Figures

Beginning October 2013, Health Insurance Exchanges, also called Marketplaces, opened to the public nationwide, offering health insurance coverage that began January 2014. For state policymakers, activity and decisions began more than three years earlier. The implementation and state responses continue for 2015. 

Next Steps in 2015:

  • The Supreme Court.  On March 4, oral arguments on the case known as King v Burwell before the U.S. Supreme Court gave mixed indications how the court stands on a case that will decide whether low- and middle-income people enrolled in federally facilitated health exchanges qualify for federal subsidies under the Affordable Care Act. 
    • Eyes, Ears on Justices Kennedy, Roberts During ACA Argument.  "For Justice Kennedy it was his questions, for Chief Justice Roberts it was his silence. … Both sides tried to claim that in this case federalism was on their side." NCSL Blog by Lisa Soronen, executive director of the State and Local Legal Center.
    • 2015 State Legislation on Changes to Health Exchange Marketplaces Structure.  NCSL's 2015 state legislation report provides a first look at states with bills to switch to a state-run exchange, while other legislators are seeking to lock-in or move to a federally-facilitated marketplace.  Read how states still have the power and option to change the structure of their exchange and the comparative results from 2014 (Updated March 6, 2015)
    • The oral argument transcript before the Supreme Court, March 4, 2015. (97 pp, PDF)
    • Maps illustrating effects of federal and state-run exchange subsidies (Credited to NCSL, ABA, KFF, 3/4/2015; posted by NY Times)
  • Exemptions and Extensions:
    A)
    HHS announced a qualified extension, from March 15 to April 30 "For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers (in federally-run states) with an opportunity to purchase health insurance coverage." The HHS Consumer notice posted March 15, 2015 defines the extension as "providing individuals and families who owe the fee when they file their 2014 taxes with one last chance to get covered for 2015."
  • B) Enrollment remains open for those with "qualifying events," from late February through November in every state, in situations such as leaving a job, having a baby, moving to a new state or coverage region etc. For typical qualifying events, the new or changed enrollment needs to be completed 60 days before or after the date of the event; read the HHS legal requirements online.  Also new small employers can enroll in the SHOP Program at any month.
  • C) Errors Prompt IRS to Waive Penalties for Exchange Enrollees.  As of April 3, 2015, the Internal Revenue Service offered exchange enrollees more time to file their tax returns without penalty because of government errors on Form 1095-A, marketplace tax statement. Consumers who are unable to file by April 15 due to problems with the form are advised to file for an automatic extension, and they will be free from any penalty as long as they file a return by Oct. 15. The Treasury Dept. had previously indicated that the filing deadline would not be extended. See the IRS's recent Q&A on Incorrect Forms and the Premium Tax Credit.
  • The nationwide deadline for "regular 2015 enrollment" was Feb. 15, 2015 for Health Exchanges, in all 50 states and D.C. (With exceptions noted above). It marked the final day of regular "open enrollment," where uninsured individuals and families could buy or change health coverage for 2015 under the Affordable Care Act (ACA).To date, more than 80 percent of people who purchased insurance have claimed a health premium subsidy, while several million others have qualified for Medicaid using Healthcare.gov or state online sites. On March 10 HHS provided this update: Nationwide, nearly 11.7 million consumers selected or were automatically re-enrolled in qualified health insurance coverage through the Health Insurance Marketplace as of Feb. 22, according to a report released March 10 by the U.S. Department of Health and Human Services.
    • 2.85 million (24 percent) were in the 14 states (including Washington, D.C.) using their own state run Marketplace platforms.
    • Of those, 8.84 million (76 percent) were in 37 states using the HealthCare.gov platform. Nearly 7.7 million individuals with a plan selection in the states using HealthCare.gov qualified for an average tax credit of $263 per month and more than half (55 percent) paid $100 or less per month after tax credits.  Summary and state figures released are posted here.

Background: The Affordable Care Act of 2010 (ACA) gave states the option to establish one or more state or regional exchanges, partner with the federal government to run the exchange, or to decline or opt out which means the establishment of a Federally-Facilitated Marketplace.  In the months and years since the law was signed, every state governments’ legislative and executive branches considered the options and made choices about how their state’s exchange would be run, whether, and how much federal start-up funds to request and accept, and determine who would regulate the new insurance products offered to residents.

This report provides both a snapshot and a detailed look at:

  1. 2015 Health Plans: The plan options and latest information about enrollment and renewals for 2015.
  2. State Roles in Exchanges: The decisions made by states and the federal decisions affecting states, from 2010 to 2015.
  3. 2014 Implementation: The start-up steps and enrollment results in year one (January - December 2014).

 

Plans and Actions for 2015

On Nov. 15, 2014 health marketplaces or exchanges began a three-month open-enrollment period for the 2015 health insurance plan year.  Exchanges provided new lists of insurance plan choices and premiums by state, and new consumer information that applies to both federal facilitated marketplaces and state-based exchanges. The reports below the map provide specifics as state decisions and federal guidance are released.  

  • Open enrollment for the 2015 coverage year began Nov. 15, 2014 using HealthCare.gov or state-run websites in all 50 states, open for small business and consumer sign-ups.
    • HealthCare.gov includes a new "see-plans" feature, for viewing 2015 prices, subsidies and choices. Users enter a zip code to see their community, or compare with a neighboring state or region, prior to needing an application.
    • 2015 Premiums "Made Easy" - A new tool for policymakers allows side-by-side price comparisons for health plans by state. A 50-state interactive map makes single-state use easier.  Posted by The Commonwealth Fund, 12/22/2014.
    • 2015 Health plan premium information for individuals and families.  This new web feature, launched by CMS Nov. 14, 2014, provides an unprecedented "all in one place" list of every health plan offered through HealthCare.gov, including 36 pricing scenarios such as "Adult individual age 21, 27, 30, 40, 50, and 60" and more than 100,000 lines of resulting monthly premiums before any subsidy reductions are applied. The material is invaluable to in-state researchers and policymakers, but not intended for use by enrollees. There is separate dental plan data with 39,000 listings.
  • "What's Hot for 2015: #1, HEALTH EXCHANGESNCSL Cover story in State Legislatures magazine, January 2015.
  • Consumer reenrollment for 2015 explained for those who first obtained coverage for 2014 -- See HHS/CMS public enrollment announcement below, released Oct. 17, 2014.
  • Insurers offering health policies on exchanges for 2015, by state - this data is included in the NCSL state report below for those states with published plans. An NCSL Blog post of Oct. 29 summarizes advance reports, and includes a new 50-state map of insurer changes.  
  • State Marketplace Approaches to Financing and Sustainability for 2015.   The Affordable Care Act provided significant start-up funds—over $4 billion has been awarded thus far—to help states set up their health insurance marketplaces. However, after January 1, 2015, there will be no more federal establishment funds awarded and state-based marketplaces, must be financially self-sustaining. Marketplaces may use a variety of approaches to fund their operations, including user fees, state appropriations, or redirecting existing revenue sources. Read the full Report, posted by The Commonwealth Fund, Nov. 7, 2014.
  • 2014 Marketplace Enrollment by the Numbers - According to reports updated in August, HHS revised the ongoing enrollment to 7.3 million, to reflect changes in coverage to private employers or Medicaid, and eligibility reevaluations and denials. Reports and 50-state results are listed and linked below the map.  Also see state news and other state summaries and news below the map. NCSL 50-state snapshot table (below)
  • First year health coverage began Jan. 1, 2014, and usually extends through Dec. 31, 2014. Those who enrolled in health coverage through Marketplaces or Exchanges now receive health services and treatment, with coverage starting the first of each month for those with "qualifying events" such as leaving a job, having a baby, moving to a new state, etc. Health insurance coverage now includes pre-existing conditions, no-charge preventive visits and subsidized premiums for those with annual incomes less than 400 percent of federal poverty level (For 2015, up to $95,400 for a family of four; an increase from the 2014 maximum of $94,000). 

New 50-State Table of State and Federal Actions to Implement Exchanges or Marketplaces

View, print or download your state(s) in PDF Format 

(Updated Mar. 2, 2015; total = 59 pages) Includes all information in the map.

MAP OF HEALTH INSURANCE EXCHANGE STRUCTURES - 2015

Use this interactive map to view individual state snapshot information. Hover on state for quick facts; Click on state for details on legislation and 2014-15 implementation.

State-Run Exchange

Cyan box

State-run authority;

interim Federal website

State-Federal
Partnership

Purple box Federally-run Individual 
Marketplace;
State-Run SHOP
Purple box

Federally Facilitated
Marketplace (Exchange)

 

Overview of State Actions, 2010 to 2015

States that created or wanted to create and run their own exchange had to submit blueprints and receive approval from the U.S. Department of Health and Human Services. By the initial December 2012 federal deadline, 18 states and the District of Columbia had submitted blueprints.  18 states and D.C. later received approval from HHS for their exchange.

  • As of late 2014, 14 states and the District of Columbia had enacted legislation to establish or authorize state-based health insurance exchanges. A few others were initiated by governors' executive orders. Massachusetts (2006) and Utah (2009) passed exchange laws prior to the enactment of the Affordable Care Act in March 2010. With Exchanges in operation, 14 states and D.C now fully operate their own state-run enrollment websites, while 36 others rely on the federal healthcare.gov, including seven federal-state "partnership" exchanges. Michigan applied for and was conditionally approved as a partnership, but is operating as a federal marketplace.
  • Utah was first to request and be approved to run the SHOP exchange while the federal government runs the individual exchange. The Utah structure is now part of the HHS exchange final rules as another option to states.
  • Mississippi's elected insurance commissioner applied for a state exchange in 2012, but did not receive HHS approval. On Oct. 1, 2013, however, Mississippi received conditional federal approval to run an online SHOP marketplace where businesses with 50 or fewer employees can buy health insurance, launched January 2014.
  • Idaho requested that the federally facilitated exchange provide initial assistance to their exchange operation and enrollment for 2014 while they continue building a fully state run exchange. The Idaho state-run website is now live for 2015, serving individuals and small employers (SHOP).
  • New Mexico obtained approval to have the federally facilitated exchange provide operation of the individual exchange for plan years 2014 and 2015. New Mexico has a state-run SHOP exchange for 2014 and 2015. Their work plan for a state-run individual marketplace is considered approved by HHS, using healthcare.gov; a separate site is now scheduled to launch in November 2015.
  • Seven states (Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and West Virginia) selected the state-federal partnership option, in which the state runs the consumer assistance and/or plan management function of the exchange. All such states were required to submit a blueprint and received HHS approval of partnership exchanges.  In 2015, plan management is being dropped by CMS/CCIIO as a formal option for state-partnership marketplaces. 
  • Arkansas's health exchange board voted to delay until 2017 the launch of its own state-run exchange for individual coverage. It plans to operate a state-run SHOP exchange for plan year 2016.
  • Illinois, in early 2014, indicated its intention to fully run its own exchange. It is approved by CMS as a state-federal partner marketplace for 2014 and continues that status for plan year 2015.
  • Oregon voted April 26, 2014 to abandon its state-run website for plan year 2015 and convert to the federal Healthcare.gov. Nevada also is using Healthcare.gov in 2015.  Both states retain their HHS approved status as a state-run marketplace.
  • 2014 State Legislation to Establish a State-Run Exchange - NCSL analysis report, updated Jan. 2, 2015.

The other states have defaulted to the federally facilitated exchange (marketplace). Every state in this federally facilitated category and the partnership category have the option of eventually running a fully state-based exchange.

2015 Responses and Implementation: Read More on Recent Developments

ACA Updates Icon

  • NCSL 50-state snapshot table (below)
  • Continuous and Special Enrollment Open: Medicaid and SHOP (small business) applicants usually do not have a enrollment deadline and may be able to sign up 12 months of the year. There also are several standard exceptions and "life events" that allow individuals to make Marketplace health insurance purchases between April 1 and November 15.
  • Employers with under 100 workers given until 2016 to offer coverage. On Feb. 10, 2014, the Treasury Department extended by one year the requirement that employers with between 50-99 workers meet the mandate to offer health insurance, a category that includes about seven percent of the private employee workforce. The new rules also will require 70 percent of workers to be covered in that first year. Read the Treasury fact sheet here [2 pp.] and final rule here [227 pp.].  
    How the federal policies affect employers:
    • Small Businesses with fewer than 50 employees: (about 96% of all employers): Under the Affordable Care Act, companies that have fewer than 50 employees are not required to provide coverage or fill out any forms in 2015, or in any year, under the Affordable Care Act.
    • Employers with 50 to 99 employees (about 2% of employers): Companies with 50-99 employees that do not yet provide specified-quality, affordable health insurance to their full-time workers will report on their workers and coverage in 2015, but have until 2016 before any employer responsibility payments could apply.
    • Larger employers with 100 or more employees (about 2% of employers): The overwhelming majority of companies with 100 or more employees already offer quality coverage.  The revised rules phase in the percentage of full-time workers that employers need to offer coverage to, starting with 70 percent in 2015 to 95 percent in 2016 and beyond. Employers in this category that do not meet these standards will make an employer responsibility payment for 2015.
    •  Explanation of eligibility for premium subsidies or Medicaid enrollment based on income - posted by HHS Nov. 4, 2014. 
    • Note: The  "2015 Federal Poverty Guidelines" were released by HHS on Jan. 22, 2015.  The guidelines increase the basic poverty number for an individual from $11,670, by $100, to $11,770.  The effect on eligibility for subsidies will be determined at a later date. [Added 1/23/15]

Table of premium subsidies for 2014-2015

  • "Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA)" [Read full text, 19 pp.] - Report by the Congressional Research Service, March 2014.

  • Explanation of Renewal Options, 2014 to 2015 (released Oct. 16, 2014) -
    CMS description to help Marketplace enrollees stay covered 

    • ‚Äč"Consumers should come back to HealthCare.gov, reach out to the call center, or visit with an in-person assister to make sure they choose the plan that best meets their needs starting November 15, 2014.

      "The Centers for Medicare & Medicaid Services (CMS) is committed to making it as easy as possible for current Health Insurance Marketplace enrollees to renew their coverage for 2015. It is encouraging consumers to come back at the start of Open Enrollment on November 15, update their 2015 application, and compare their options to make sure they enroll in the plan that best meets their budget and health needs for next year. In mid-October consumers will begin to receive notices from the Federally-facilitated Marketplace in the mail and in their HealthCare.gov accounts, explaining how they can renew their coverage during Open Enrollment.

      If consumers do not return to the Marketplace to update their application, they generally will be auto-enrolled in the same plan - with the same amount of advance payment of the premium tax credit and same cost-sharing reductions – as the 2014 plan year. They can change plans during open enrollment through February 15, with coverage in their new plan starting on the first day of the next or second month depending on when they enroll. To help consumers understand the renewal process, CMS published the "5 Steps to Staying Covered"- Consumers can learn more here"
      Federal Marketplace notices and professional training materials are available here.

[Disclaimer: NCSL provides links to third-party sources for information only and is not responsible for opinions or links contained on such websites.]

  • State-by-State Information Contacts for ACA Enrollment - An NCSL Resource for Legislatures (For use to assist with new enrollment by consumers or small employers)
  •  Online SHOP Exchanges for small businesses delayed until 2015.  In  2013 the Obama Administration announced another delay for SHOP the small businesses option to buy group insurance online for employees through the marketplaces run by the federal government in 36 states. This feature was rescheduled to be in place in November 2014 for coverage in 2015.  Small employers could use paper applications to buy through a federal marketplace for 2014, often using an insurance broker. The 14 state-run exchanges are permitted to use online tools to sign up small employers through SHOP. Small businesses with up to 25 employees can be eligible for premium subsidies, but only if the purchase is made through an exchange, and not the commercial market outside of the exchanges or marketplaces. The new HHS guidance for SHOP as of late November states: "You enroll in SHOP coverage directly through an agent, broker, or insurance company. Work with an agent, broker or insurance company to help you apply for SHOP eligibility and find and compare available SHOP plans. You can also use the HHS premium estimation tool on HealthCare.gov to browse and compare plans and pricing information."  More.
  • Characteristics of Those Affected by a Supreme Court Finding for the Plaintiff in King v. Burwell and The Implications of a Supreme Court Finding for the Plaintiff in King vs. Burwell: 8.2 Million More Uninsured and 35% Higher Premiums These  two briefs describe the characteristics of those that would be affected, particularly those who would otherwise have nongroup insurance. Of the 9.3 million people estimated to lose tax credits, two-thirds would become uninsured. Most are adults who are low and middle income but not poor, most are white, non-Hispanic, and most reside in the South. Financial burdens would increase substantially for those wishing to continue buying the same coverage they would have under current implementation of the law. Released by The Urban Institute, Jan. 8 and Jan. 22, 2015.
  • Planning for 2016: Insurers must apply by April 15
    According to CMS’ draft letter to insurers released in December, insurers participating in Federally Facilitated Marketplaces (FFMs) must submit a completed QHP application for all plans they intend to offer on an FFM by April 15. These applications will include a package of plans and benefits, rates data and provider networks. The review and revision phase will last through August 14. In general, state departments of insurance will play a significant role in reviewing these plans for compliance with market-wide requirements. For certain areas, such as network adequacy, CMS will examine insurers’ compliance. If a QHP application is approved, insurers will receive the certification notices and sign the contract agreement to get ready for the third open enrollment period. These tentative key dates are for insurers participating in FFMs, but State Based Marketplaces (SBMs) are advised to follow the same timeline.

[Disclaimer: NCSL provides links to third-party sources for information only and is not responsible for opinions or links contained on such websites.]

By the Numbers: 2014 Enrollment Results in Detail

The enrollment process for the first year of ACA Marketplaces and Exchanges was the subject of intense scrutiny and commentary.  One result is an unprecedented quantity of reports, charts, maps and media coverage.  This state-specific material remains useful as the nation begins the new tally of 2015 enrollment.

  • About 3.8 million people enrolled in Health Insurance Marketplace plans in the final reporting period, which began March 2 and concluded on April 19. In August 2014, HHS revised the ongoing enrollment to 7.3 million, to reflect changes in coverage to private employers or Medicaid, and eligibility reevaluations and denials.
  • Medicaid and CHIP:  An HHS report released Aug. 8, 2014, calculated "more than 7.2 million additional people enrolled in Medicaid and the Children’s Health Insurance Program" compared to pre-October 2013.
    • 5 million people are enrolled in plans that meet ACA standards outside the Marketplace, according to a CBO estimate. When insurers set premiums for next year, they are required to look at everyone who enrolled in plans that meet ACA standards, both on and off the Marketplace.
    • 3 million young adults gained coverage based on the Affordable Care Act by being able to stay on their parents' health plan, with enrollment that began in October 2010.
    • State enrollment figures in detailMarketplace Enrollment Report. (released May 1, 2014, 45 pages PDF)  For State by States Tables (22 pages, PDF).  Medicaid through Exchanges: Enrollment Report. released May 1, 2014.  Detailed numbers are available, by states, individual insurers and local rating districts in Word, and Excel formats.  The comprehensive dataset, HIX Compare, contains: Premium information for all 7,027 Silver plans being sold through the ACA health insurance exchanges;  Benefit design and cost sharing requirements for all 1,208 unique Silver exchange plans.Posted by the Robert Wood Johnson Foundation. 

More Key Exchange and Health Reform Resources

  • American Health Benefit Exchange (Federal Overview)
    Includes information on essential health benefits packages, model legislation from NAIC, federal requirements for exchanges and guidance from HHS.
  • Implementing the Affordable Care Act:
    State Approaches to Premium Rate Reforms in the Individual Health Insurance Market - December 2014 by The Commonwealth Fund [18 pages, PDF)
  • Implementing the Affordable Care Act: Key Design Decisions for State-Based Exchanges - July 2013 by The Commonwealth Fund [22 pages, PDF)
  • Premium Affordability, Competition, and Choice in the Health Insurance Marketplace, 2014 (PDF-26 Pages), U.S. HHS/ASPE Research Brief, published June 2014.
    This brief provides an overview of health insurance plan premiums available in the 2014 Marketplace and the important role of the advanced premium tax credit (“tax credit”) in helping families afford coverage. It contains information on the change in the premium cost associated with the tax credit for individuals who made Marketplace plan selections through the Federally-facilitated Marketplace (FFM) during the initial open enrollment period. Also, it analyzes over 19,000 Marketplace plans for 2014, within four metal levels (bronze, silver, gold, and platinum) for each of the 501 rating areas across 50 states and the District of Columbia. Tax credits reduced premiums by approximately 76 percent, on average, for individuals who selected plans in the FFM with tax credits. Competition, as measured by the number of issuers in a rating area, was associated with more affordable benchmark plans (the second-lowest cost silver plan).
  • Health Reform 2014 State Legislative Tracking Database  | The latest listings, with summaries and status for more than 1,140 filed measures. Updated very two weeks through December 2014. Archive available: Health Reform 2011-13 State Legislative Tracking Database
  • The ACA: a 2014 Interim Report Card; an NCSL presentation - www.ncsl.org/Portals/1/Documents/Health/Cauchi-AHCJ-HIRC.pdf

U.S. Department of Health and Human Services
U.S. Department of Labor

State Table 2A:
National Snapshot of Exchange Actions and Figures, 2015

(also see map above and table)

2015 Plan Year
Federally Facilitated Marketplace

Snapshot (37 states only)

Cumulative 3 month Total
Nov 15 – Feb 15

Week 13
Feb 7 – Feb 15

Source:

HHS_Weekly_Snapshot, 2/18/2015

Plan Selections

8,797,577**

1,048,202

 

Applications Submitted

12,178,433

1,533,031

 

Call Center Volume

14,406,068

2,282,380

 

Average Call Center Wait Time

8 minutes 16 seconds

22 minutes 41 seconds

 

Calls with Spanish Speaking Representative

1,380,736

274,588

 

Average Wait for Spanish Speaking Rep

1 minute 22 seconds

6 minutes 21 seconds

 

HealthCare.gov Users

32,516,835

6,152,404

 

CuidadoDeSalud.gov Users

1,297,733

226,995

 

** Approximately 200,000 people who signed up have been found ineligible due to lack of citizenship documentation.

Sources: HHS Weekly Snapshot, 1/21/2015; compare to HHS Weekly Snapshot, 1/14/2015

www.ACASignups.net - updated February 2015

 

State Table 2B: 2014 and 2015 State by State Enrollment Summary

 Full Report sources also available:

      Key: Allow Renewal: 1st "Y"= now: 2013 state policy; 2nd "Y" or "N"= updated state policy for plan year 2014. 

        ~ = not decided; not available

The box allows you to conduct a full text search or use the dropdown menu option to select a state.

STATE ACTIONS AND FIGURES

State

Enacted 
Exchange

Statute

Did Not Pass
Exchange
Legislation***

2015 Enrollment
(as of 2/15/15  coded as ♦
2/22/15 = ♦♦
2014 Enrollment
health insurance
Selected a Plan

as of date listed

Eligible for 2014 Enroll-
ment for  Medicaid/CHIP

as of date listed

Allow
Renewal:
now / futur
e
as of 1/1/2014

 Alabama

 

2011, 2012

168,816

20,897

204,187

97,870 (4/19/14)

 

 Alaska

  2011, 2012 16,724 12,890 (4/19/14) 4,172 (3/31/14) Y / N

 Arizona

 

2011, 2012 169,178 120,071 (4/19/14) 101,282 (3/31/14) Y / ~

 Arkansas

 

2011

64,947

43,446 (4/19/14) 73,681 (3/31/14) Y / N

 California

State-run
2010

  1,412,200 1,405,102 (4/19/14)

1,700,000 (3/31/14)
(630,000 from
Low Income Health Program

N / N
 Colorado State-run
2011
  140,327 ♦♦

125,402 (4/19/14)

181,983 (3/31/14) Y / Y

 Connecticut

State-run
2011

  109,839 ♦♦ 79,192 (4/19/14) 138,908  Y / N

 Delaware

Exec. action

  24,887 14,087 (4/19/14)

7,663 (3/1/14)

Y / N
 District of Columbia State-run
2012
  18,465 ♦

 10,714 (4/19/14)

19,464  Y / N

 Florida

-

-

1,600,006

983,775 (4/19/14) 180,479 (3/31/14) Y / Y      

 Georgia

 

2011, 2012 536,929 316,543 (4/19/14) 91,914 (3/31/14) Y / Y
 Hawaii State-run
2011
  23,000 8,592 (4/19/14) 39,282 (1/10/14)
2,148 eligible via CHIP
 
 Idaho State-run 2012 97,079 ♦ 76.061 (4/19/14) 10,709 (3/31/14) Y / ~

 Illinois

2011 (intent)

  347,300 217,492 (4/19/14) 181,070 (3/31/14) ~ / Y

 Indiana

 

2011 218,617 132,423 (4/19/14) 94,495 (3/31/14) Y / N
 Iowa   2011, 2012 45,399 29,163 (4/19/14) 36,891 (3/31/14) Y / N
 Kansas   2011 96,226 57,013 (4/19/14) 13,961 (3/31/14) Y / Y

 Kentucky

State-run
Exec. order

  106,330 ♦♦ 76,000 (10/1/14)  
+475 employers

357,990 (3/31/14) 

Y / Y

 Louisiana

 

2012 184,532 101,778 (4/19/14) 14,359 (3/31/14)  Y / Y

 Maine

 

2011, 2012 74,792 44,258 (4/19/14) 7,103 (3/31/14) Y / Y

 Maryland

State-run
2011

- 119,096 ♦ 67,757 (4/19/14)  163,602 (3/31/14) Y / N

 Massachusetts

State-run
2006

- 134,037 31,695 (4/19/14) n/a N* / N

 Michigan

 

2012 340,905 272,539 (4/19/14) 40,347 (3/31/14)  Y / Y

 Minnesota

State-run
2011, 2012

  58,673 48,495 (4/19/14) 144,481 (3/31/14) Y / N

 Mississippi

state run SHOP only

  103,601 61,494 (4/19/14)  13,779 (3/31/14) Y / N
 Missouri     253,969 ♦ 152,335 (4/19/14) 45,513 (3/31/14)  
 Montana     54,346 ♦ 36,584 (4/19/14) 4,638 (3/31/14)  
 Nebraska - - 74,124 ♦ 42,975 (4/19/14)  9,879 Y / N
 Nevada Exec. action;
State-run
using federal web in 2015
- 72,127 ♦ 45,390 (4/19/14) 182,946 Y / N

 New  Hampshire

 

2011 52,944 40,262 (4/19/14) 7,235 Y / Y

 New Jersey

2012 vetoed

2012

252,792

472,000

(2/15/15)

161,775 (4/19/14) 179,872 ~ / Y
 New Mexico 2011 vetoed state run SHOP only  2012 51,857 32,062 (4/19/14)
   166 SHOP
30,147 Y / ~

 New York

State-run
Exec. order

- 405,488 ♦ 960,762 (3/16/14)
370,451 HHS (4/19)
646,018 (3/31/14)  N / N

 North Carolina

2011 (intent)

2011 559,473 357,584 (4/19/14) 73,898 Y / Y

 North Dakota

 

2011 18,125 10,597(4/19/14) 6,843 ~ / Y

 Ohio

 

2012 234,507 154,668 (4/19/14)  156,899 Y / Y
 Oklahoma   2011, 2012 124,838 69,221 (4/19/14) 17,374 Y / N

 Oregon

2012

State-run
using federal web in 2015

  110,228 68,308 (4/19/14) 207,329 N / N
 Pennsylvania   2012 471,930 318,077 (4/19/14) 42,335 ~ / Y

 Rhode Island

state-run

2011 30,744 28,485  (4/19/14) 
SHOP: 107 employers = 658
70,243 N / N

 South Carolina

 

2011, 2012 209,773 118,324 (4/19/14) 28,359 Y / Y
 South Dakota     21,183 13,104 (4/19/14) 3,850  

 Tennessee

 

  229,093 151,352 (4/19/14)  83,591 Y / Y

 Texas

 

2011 1,189,316 733,757 (4/19/14) 141,494 Y / Y

 Utah

2009
state run SHOP only

  140,221

84,601 (4/19/14) 
357 SHOP employers

50,268 Y / Y~
 Vermont State-run
2011
  31,552 38,048 (4/19/14) 41,704 Y / N

 Virginia

2011 (intent)

2012 384,612

216,356 (4/19/14)

48,660

Y / N

 Washington State-run
2011
  160,000~ 163,207 (4/19/14) 628,893 N / N
 West Virginia 2011 law not implemented federally-facilitated 33,091 19,856 (4/19/14) 21,019 Y / N

 Wisconsin

 

2012 205,839 139,815 (4/19/14) 81,274 Y / Y

 Wyoming

-

- 21,128 11,970 (4/19/14) 2,216 (3/31/14) Y / Y
             

♦ 2015 Enrollment lists "total number of individuals who have selected a 2015 Marketplace plan" through Feb. 15, 2015.  To have coverage confirmed or "effectuated" consumers need to pay their first month's health plan premium. This list does not include statistics on such payments.
♦ State-run are figures through Dec. 15, 2014. More recent state-run exchange reports are coded (♦) or dated individually. People who enrolled for plan year 2014 and have "auto-enrolled" for 2015 without change generally are not included in this 2015 column.

[Disclaimer: NCSL provides links to third-party sources for information only and is not responsible for opinions or links contained on such websites.]

 

Notes for "Health Insurance Exchanges or Marketplaces: State Actions" 50-state tables

1 Declaration refers to the decision the state made in regards to developing a state based health insurance exchange. This section provides links to the declaration letter and the approval or conditional approval from HHS. Resource: The Center for Consumer Information and Insurance Oversight, HHS, Jan. 4, 2013.

2Structure refers to where the exchange will be housed in the state.

3 Governance refers to the governing board outlined in the law.

4 Selection of Carriers is regarding how a state will operate the exchange. States have options to operate their exchange from an “active purchaser” model in which the exchange operates as large employers often do, using market leverage and the tools of managed competition to negotiate product offerings with the exchange..To the “open marketplace” in which the exchange operates as a clearing house that is open to all qualified insurers and relies on market forces to generate product offerings as is the case in CO and UT. For these states, This means that any insurer that meets the Qualified Health Plans standard can participate in the exchange. On the other hand, a state governing board can participate in selective contracting and pick and choose which insurers are allowed to participate as is the case in CA, MA, and CT.

5 Highlights include announcements, unique facts, etc.

6 Federal Grants are a part of the Affordable Care Act and are available to states to plan and implement exchanges. State exchanges must be financially self sufficient by 2015.

7 California was the only state to enact exchange establishment in 2010.
***For details on 2011-2013 bills that did not pass, please click here to access the NCSL bill tracking database.  
Massachusetts and Utah passed laws prior to the enactment of the Affordable Care Act in March 2010.

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