Post by LWPD on Jul 22, 2012 8:16:14 GMT -5
Below is a snapshot of actions each state is taking since the US Supreme Court upheld the constitutionality of the health care law. States must set up health exchanges by January 2014 in order to qualify for billions of dollars in federal funding. Since 1980, total medical costs in the US have grown from 6 percent of GDP to 18 percent of GDP. Time will tell if the Affordable Care Act will stem that tide.
Courtesy of USA Today
How each state will approach health care act
Where the states stand on healthcare
Here is a look at where each of the 50 states stand on implementing President Obama’s federal health care law.
Connecticut
Under Gov. Dan Malloy, a Democrat, Connecticut plans to fully implement the health care act and meet all deadlines. The state has hired staff and a board of directors to begin implementing health care exchanges and have them in place by the 2014 deadline set by the federal law. Connecticut already allows people under 26 years old to stay on their parents’ health insurance policies, which is part of the federal law.
New England Region
Maine
The state has passed laws implementing components of the law, such as allowing parents to add coverage of children up to age 26 and outlawing denial of insurance coverage due to pre-existing conditions. Maine has also passed a law that will allow consumers to shop out-of-state for coverage.
Massachusetts
A sweeping health care law was passed in 2006 that became the blueprint for the federal overhaul. Many of the key elements of the federal law, including the “individual mandate†requiring nearly everyone have insurance, remain the law in Massachusetts.
New Hampshire
Currently laws that echo portions of the Affordable Care Act are in place, such as allowing dependent unmarried residents to remain on their parent’s health care insurance until age 26. Gov. John Lynch, a Democrat, last month signed a law preventing the state from establishing an insurance exchange. That means the state’s exchange will be run by the federal government.
Rhode Island
The state has received $58 million in federal funds to assist in the creation of its health benefits exchange. Gov. Lincoln Chafee, an independent, says “the state has already done tremendous work to establish a (state-based) exchange.â€
Vermont
The state is setting up the exchange on its own, with the help of federal funds.
Middle Atlantic Region
New Jersey
The state is weighing whether letting the federal government set up the state health insurance exchange would be a less expensive option. Gov. Chris Christie said he’s not sure New Jersey needs to expand Medicaid under the federal law because the state’s program for the poor and disabled already is inclusive.
New York
Gov. Andrew Cuomo, a Democrat, has ordered the establishment of a state-based health exchange aimed at the roughly 2.7 million New Yorkers lacking health insurance. The state also will expand Medicaid.
Pennsylvania
Republican Gov. Tom Corbett will push the state to set up its own exchange ‘“because it can do it better than the federal government.â€
South Atlantic Region
Delaware
Officials are working on a health care exchange and accepting public input as they come up with minimum coverage requirements that must be included in health care plans for individuals and small businesses. The state is still reviewing its options for Medicaid expansion.
Florida
Republican Gov. Rick Scott ordered the state not to accept federal money for implementing the health care law. Florida has rejected or declined to pursue more than $106 million and has returned $4.5 million. The state has not implemented an exchange that would meet the requirements of the federal law.
Georgia
Georgia has done nothing to implement a health care exchange. Lawmakers have introduced bills that would either allow or hinder implementation of the law, though none have passed. The state is waiting for the outcome of the presidential election.
Maryland
Legislation has passed in Maryland to create a health care exchange, setting up standards and regulations to run the program and creating the framework for a marketplace where individuals and small businesses can purchase coverage.
North Carolina
Legislation aimed at prohibiting the mandate for individuals to buy health insurance was the first item introduced after Republicans took over control of by North Carolina’s General Assembly last year. The Legislature did not set up a health care exchange before adjourning this year and Gov. Bev Perdue, a Democrat, is reviewing options
South Carolina
The state, which is among the states that sued over the constitutionality of the federal health care law, opted not to implement health care exchanges after a panel concluded there were too many unanswered questions. South Carolina is delaying action until after the presidential election.
Virginia
The state has expressed its intent to create a health care exchange, but Republican Gov. Bob McDonnell has not acted on recommendations made by a gubernatorial advisory council. Virginia filed its own lawsuit challenging the health care law, but lost in federal appeals court.
West Virginia
Legislation has been allowing for a state-run health care exchange and the state plans to work with the federal delegation on how to move forward.
East South Central Region
Alabama
Republican Gov. Robert Bentley, a physician, created a commission in 2011 to recommend a plan for a health insurance exchange, but he successfully opposed efforts by some legislators to enact one in May. The state is reviewing the larger implications of the law.
Kentucky
The state will operate its own insurance exchange but has not decided whether to expand Medicaid.
Mississippi
Insurance Commissioner Mike Chaney, a Republican, has been working on a health care exchange and has accepted federal money for the project. The state is moving to establish a free-market health insurance exchange but will not expand Medicaid.
Tennessee
The state has laid the groundwork for a health insurance exchange but prefers a state-run exchange.
East North Central Region
Illinois
The state has received three federal grants to study and start building its health insurance exchange, but the Legislature has failed to pass a law establishing it. Gov. Pat Quinn, a Democrat, has considered an executive order to do that, but now may pursue a federal-state partnership instead.
Indiana
No decision has been made to establish a state-based exchange and the decision to expand Medicaid will be made by the next governor and Legislature.
Michigan
The Department of Licensing and Regulatory Affairs has been working to set up a health insurance exchange but has had limited success because House Republicans refuse to let it use $9.8 million in federal planning dollars. Because of looming federal deadlines to have an exchange in place, state officials are planning for a state-run exchange while also talking to federal officials about a possible partnership on a federal exchange where the state handles just some responsibilities, such as customer service.
Ohio
The state will allow the federal government create a health exchange for the state but is reluctant to expand Medicare.
Wisconsin
The state has not begun setting up its health insurance exchange. Wisconsin does not plan to take any action until after the presidential election.
West North Central Region
Iowa
The state does not have a law establishing a health insurance exchange, and Republican Gov. Terry Branstad says the state has already enacted several pieces of the law, including a website that helps residents find insurance, but the state has yet to comply with other requirements.
Kansas
The Republican-dominated state government has been hostile to the 2010 federal law and hasn’t moved to set up a health care exchange. No decision will be made until after the presidential election.
Minnesota
The state has embraced the health care overhaul more than many states. Democratic Gov. Mark Dayton used a provision in the federal law to extend Medicaid coverage to more than 80,000 vulnerable adults as soon as he took office in 2011. His administration has focused on developing an online health insurance exchange envisioned as a key part of the law, securing $28.4 million from the federal government for Minnesota’s planning efforts.
Missouri
The state received an initial planning grant but has not implemented a health insurance exchange. Missouri is currently reviewing the ruling.
Nebraska
The Legislature in 2011 passed a bill implementing the Silver State Health Insurance Exchange and creating a seven-member board to oversee it. Republican Gov. Brian Sandoval opposes the federal health care law and is reviewing the ruling to understand its implications.
North Dakota
The state is not moving to implement the law because of its cost and complexity.
South Dakota
Republican Gov. Dennis Daugaard has delayed work on setting up a health insurance exchange until after the presidential election.
West South Central Region
Arkansas
The state decided on a federal-state partnership for its health insurance marketplace. Legislators blocked a bill by which the state would have created its own insurance exchange but have since accepted a grant that will allow it to at least have a role in the federally created exchange.
Louisiana
The state has not implemented health care exchanges and is waiting for the results of the presidential election.
Oklahoma
The state has not implemented health care exchanges and is waiting for the results of the presidential election. Oklahoma hasn’t decided whether to expand Medicaid coverage to more uninsured adults.
Texas
The government has not implemented a health care exchange. Texas has joined with other states in challenging the law in court. Gov. Rick Perry, who is vocally opposed to the law, says the state can “deliver health care more efficiently, more effectively and cheaper than the federal government can.â€
Mountain Region
Arizona
The state is among those challenging the constitutionality of the health care overhaul. The lawsuit covers about 22,000 people statewide, including some 14,000 people in the Phoenix area. Republican Gov. Jan Brewer’s administration has made no decision.
Colorado
Lawmakers passed legislation in 2011 to set up health insurance exchanges, and a commission is in the process of implementing them. The exchanges are set to start October 2013.
Idaho
The state has not implemented health insurance exchanges, over objections from insurers including Blue Cross of Idaho. The state is waiting for the results of the presidential election.
Montana
Gov. Brian Schweitzer, a Democrat, says Montana is reviewing the decision.
Nevada
Legislature in 2011 passed a bill implementing the Silver State Health Insurance Exchange and creating a seven-member board to oversee it. Republican Gov. Brian Sandoval opposed the federal health care law as a candidate. The state is setting up a health insurance exchange and using funds provided in the law to do so
New Mexico
The state is developing its own insurance exchange and wants to have the revamped Medicaid program implemented in the fall of 2013.
Utah
The state implemented a health insurance exchange before the federal Affordable Care Act was passed to help small businesses obtain insurance coverage for their employees. Utah is among 26 states that sued the federal government over the law. Utah may not expand Medicaid.
Wyoming
While the state has not implemented health care exchanges, a steering committee is studying an exchange for Wyoming and will present a report to the Legislature this fall.
Pacific Region
Alaska
Among the states that sued over the constitutionality of the federal health care law, Alaska has yet to implement a health care exchange. The health department has hired a consultant to help design one, and that report is expected soon. It may be months before decisions are made on Medicaid expansion and a health care exchange.
California
Parts of legislation are already implemented, including creating the beginnings of health care exchanges to provide consumers a marketplace to purchase insurance policies starting in 2014. The state has also already banned insurers from refusing coverage for children with pre-existing illnesses and young adults are allowed to stay on their parents’ plans through age 26.
Hawaii
The state joined several states last year in filing a friend-of-the-court brief in support of the law. Gov. Neil Abercrombie, a Democrat, said at the time the law preserved the best elements of Hawaii’s long-standing health care statutes. The state also used a $300,000 private grant to create a state job for a coordinator to implement the overhaul. Hawaii plans to develop its own insurance exchange, a key component of the federal overhaul.
Oregon
The state is working aggressively to implement the health care law and is farther along than most other states. The federal government has committed more than $60 million in grants to develop a health insurance exchange that could be duplicated in other states.
Washington
Republican Attorney General Rob McKenna signed on to the health care lawsuit against the wishes of the state’s Democratic governor and majority Democrats, but Washington state moved ahead this past legislative session with implementing its own health insurance exchange.
States are sharply divided on how — or whether — to implement the Patient Protection and Affordable Care Act after it was upheld by the U.S. Supreme Court.
Indiana Gov. Mitch Daniels on how his state will approach the Affordable Care Act: "Absolutely no decision has been made to establish a state-based exchange."
The health care law was enacted in March 2010, but its two major expansions of health coverage don’t begin until January 2014.
One is the creation of health care exchanges — government agencies or non-profit groups that will organize and oversee a private market for buying health insurance. The exchanges will offer a choice of certified health plans from which individuals and small businesses can choose.
States are expected to establish exchanges or create partnerships with the federal government. If states don’t act, a federal exchange is supposed to serve those residents.
In addition, the law calls for a vast expansion of Medicaid, the federal-state health insurance program for the poor and people with disabilities. For the first time in most states, adults earning up to 138% of the federal poverty rate, or $31,809 for a family of four, would be covered.
As passed and signed by President Obama, the law threatened states with the loss of all federal Medicaid funds if they did not expand their programs. The Supreme Court struck down that provision, freeing states to sidestep the expansion without losing other funds.
USA TODAY interviews with governors, top aides and health care officials show some states forging ahead on the law and others are holding back (number in parenthesis is the estimated percentage of people in each state who have no health insurance):
Alabama (16%). “We do not know if the state can afford to expand Medicaid,†says Jennifer Ardis, press secretary for Gov. Robert Bentley, a Republican and a dermatologist. “We have serious concerns about the increased costs associated with expanding entitlement programs, but we need to understand the larger implications of the ruling as a whole to determine how many Alabamians might be subject to the Obamacare tax before deciding the best course of action.â€
Alaska (18%). Gov. Sean Parnell, a Republican, “has directed the state departments of Law and Health and Social Services to review the (court) decision. It may be months before decisions are made on Medicaid expansion and a health care exchange,†says Sharon Leighow, Parnell’s press secretary.
Arizona (19%). “At this point, the governor has made no decision†on the insurance exchange and Medicaid expansion, says Ann Dockendorff, spokeswoman for Gov. Jan Brewer, a Republican. “We are actively planning to see what role an exchange would play in — and how the ruling will impact — Arizona’s health care system.†Brewer says, “It is now up to the American people to save our country from the fiscal and regulatory nightmare known as Obamacare. … If Arizonans are to have access to the health care they need from the provider they choose, Obamacare must be fully repealed.â€
Arkansas (19%). The state will rely on the federal government for an insurance exchange. The state will expand Medicaid services, says Gov. Mike Beebe, a Democrat. “If (working people) have the opportunity to have health care coverage, and if it’s going to be paid for by the federal government … I don’t know how we leave our people out,†he says.
California (19%). The state is “about halfway†toward a Web-based enrollment system to meet the Jan. 1, 2014, deadline for health exchanges, says Diana Dooley, secretary of the state’s Health and Human Services Agency. California will expand Medicaid and is expecting a 10% enrollment increase, Dooley says. But California faces a $15.7 billion budgetary shortfall in the 2012-13 fiscal year, according to state estimates. A more than $8 billion tax hike is on the ballot for voters’ consideration in November to help close the gap. “If that initiative fails in November, we will have to evaluate what impact that will have on our ability to fully implement the (health care) reforms,†Dooley says.
Colorado (14%). The state created a health insurance exchange in 2011, says Lorez Meinhold, senior policy director for Gov. John Hickenlooper, a Democrat. People will be able to begin purchasing insurance in October 2013 for coverage beginning Jan. 1, 2014. “We are creating a Colorado-based system. But we do still need the federal dollars and will go after the federal dollars to build the Colorado exchange,†Meinhold says. The state is not waiting for the election and has already begun using Medicaid to cover some people without insurance.
Connecticut (11%). Under Gov. Dan Malloy, a Democrat, Connecticut plans to fully implement the health care act and meet all deadlines. The state already authorized an insurance exchange and expects to runs its own, says Benjamin Barnes, Connecticut secretary of policy and management. The Medicaid expansion could save the state roughly $300 million a year because the state already voluntarily covers some low-income adults without insurance. The new law will let the state expand coverage of adults from the current 60% of the poverty level — for which the state pays 50% of the cost — to 133% of the poverty level while the federal government pays 100% of the costs for the first three years, Barnes says.
Delaware (12%). “We do not plan a standalone state exchange but have been working … toward a federal partnership exchange,†says Gov. Jack Markell, a Democrat. “We are still reviewing our options on Medicaid expansion and anticipate further guidance†from the federal government.
District of Columbia (12%). The District plans to implement a health insurance exchange by Oct. 1, 2013, and has already expanded Medicaid. “We will continue to move forward with implementation of this landmark legislation for District residents,†says Wayne Turnage, director of the Department of Health Care Finance.
Florida (21%). “Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program,†says Gov. Rick Scott, a Republican. The state also won’t build insurance exchanges. “Florida already has health care safety net programs for those with the greatest need, including Florida KidCare to ensure no child goes without health care in Florida. … But even though the federal government has promised to initially pay 100% of the increase in Medicaid payments for the first three years of Obamacare, the burden increasingly shifts to Florida taxpayers in future years. Medicaid, which has been growing for years 3½ times as fast as Florida’s general revenue, will soon grow even faster under Obamacare, and education funding will be adversely impaired if we do not control the growth in Medicaid spending.â€
Georgia (20%). “It’s far too early to say how we’re going to approach the Medicaid expansion,†says Gov. Nathan Deal, a Republican. “The court changed the rules of the game on expansion and we’ll need to see what the executive branch issues in regulations. … We will wait until the election, which will determine our next steps. However, Obamacare is far too costly for the state with the estimated $4.5 billion in new costs over the next 10 years. … We have to look at the most cost effective ways to increase insurance coverage for Georgians. From the state perspective, it’s unaffordable.â€
Hawaii (8%). “We are planning to fully implement our state-based exchange and the Medicaid expansion,†says Gov. Neil Abercrombie, a Democrat.
Idaho (17%). “Obamacare has been bad for America from the beginning,†says Gov. C.L. “Butch†Otter, a Republican. “Change is now in the hands of the American people and we must elect a new president and congressional candidates who will repeal Obamacare.â€
Illinois (15%). The state will work with the federal government to set up an insurance exchange. The state supports expanding Medicaid. “We’ll move forward to deliver the benefits of the Affordable Care Act to millions of people in Illinois,†says Deputy Gov. Cristal Thomas, a Democrat.
Indiana (14%). “Absolutely no decision has been made to establish a state-based exchange,†says Gov. Mitch Daniels, a Republican. “Before a decision can be made, the state needs more information about how a federally based exchange will operate and be funded. … A Medicaid expansion would put 1 in 4 Hoosiers (approximately 500,000 new enrollees) in Medicaid at a cost of approximately $2 billion over 10 years.†Daniels says a decision on whether to expand Medicaid will be made by the next governor and Legislature.
Iowa (12%). Gov. Terry Branstad, a Republican, joined the lawsuit against the law “because he calculated that it would cost $800 million for 150,000 new Iowans to join the Medicaid rolls, which is something neither Iowa nor the federal government can afford,†says Tim Albrecht, a spokesman. “His goal is to make Iowa the healthiest state in the nation through other methods.â€
Kansas (13%). Gov. Sam Brownback, a Republican, says no decision on expanding Medicaid or creating an insurance exchange will be made until after the November election. “It’s a political question now,†he says.
Kentucky (15%). The state will operate its own insurance exchange but has not decided whether to expand Medicaid, says Kerri Richardson, communications director for Gov. Steven Beshear, a Democrat.
Louisiana (17%). “Come this November, we are going to elect a new president and a new Congress who will repeal and replace Obamacare,†Gov. Bobby Jindal, a Republican, says. “That’s why we have refused to implement the Obamacare health exchange or the Medicaid expansion.â€
Maine (10%). Gov. Paul LePage, a Republican, says the court ruling “has verified what President Obama has refused to admit all along, which is to say this law is an enormous tax on the American people. The federal government can force you to do or buy anything, as long as they call it a ‘tax.’ This massive tax hike will only destroy the American economy as it forces us over the financial cliff. … It is now up to the American people to demand full repeal of Obamacare. The Washington, D.C., elites cannot and should not run our lives.â€
Maryland (13%). Under Gov. Martin O’Malley, a Democrat, the state has “passed legislation to create a health care exchange, setting up standards and regulations to run the program and creating the framework for a marketplace where individuals and small businesses can purchase coverage,†says Raquel Guillory, a spokeswoman for O’Malley. Maryland also supports expanding Medicaid.
Massachusetts (5%). Gov. Deval Patrick, a Democrat, expects Massachusetts to fully adopt the federal law and will have to make only small changes in its existing system of universal health coverage, which the federal law is modeled after. The health insurance exchange must reconcile some differences between the state and federal law by 2014, such as the amount of the penalty for not buying insurance and the income levels that trigger the penalties.
Michigan (13%). No state GOP leaders, including Gov. Rick Snyder, have committed to adding roughly 500,000 uninsured residents to the Medicaid rolls beginning Jan. 1, 2014 — despite a federal pledge to pay the full tab the first two years and ultimately 90% of all costs after that. Even if the federal government ultimately pays 90% of the expanded Medicaid costs, Michigan’s share could run $200 million annually, according to the Senate Fiscal Agency. Sara Wurfel, Snyder’s spokeswoman, says the administration wants to study the cost of expanding Medicaid coverage — in concert with lawmakers — to determine the “best course of action†for the state. State Senate Minority Leader Gretchen Whitmer, D-East Lansing, says she worries that the issue will become mired in a partisan slugfest, perhaps leading the state to miss out on critical federal dollars to help its neediest citizens.
Minnesota (9%). The state will keep planning to develop a health-coverage exchange and to expand Medicaid, says Lucinda Jesson, commissioner of the Minnesota Department of Human Services. Bills have been introduced to create a state exchange, but the GOP-controlled Legislature elected not to pass one. Gov. Mark Dayton, a Democrat, last year extended Medicaid to 84,000 adults earning less than $8,400 a year.
Mississippi (19%). The state is moving to establish a free-market health insurance exchange but will not expand Medicaid, says Gov. Phil Bryant, a Republican. “Even when the expansion is fully funded by the federal government, the state would still have to come up with an additional $110 million in administrative costs to support the 400,000 potential new participants,†Bryant says. “I plan to work with conservatives across the county to elect Mitt Romney, so we can repeal and replace Obamacare.â€
Missouri (14%). “We’re just now beginning to review this ruling so that we can understand exactly what it means for Missouri,†says Gov. Jay Nixon, a Democrat. “This ruling has significant complexities and implications for families, health care providers and insurers.â€
Montana (17%). Gov. Brian Schweitzer, a Democrat, says: “We are reviewing the decision. Unlike the federal government, Montana can’t just print money. We have a budget surplus and we’re going to keep it that way. The federal law means Montana’s Medicaid population will double. … Preliminary estimates … indicate an additional 84,000 people will be eligible for Medicaid here by 2019 — at an estimated cost of more than $1.2 billion by the same year. With Montana’s share of the bill estimated at $71 million, a new approach to controlling health care costs is needed. There are still a lot of unanswered questions.â€
Nebraska (12%). Gov. Dave Heineman, a Republican, says: “My biggest concern is that an unfunded expansion of Medicaid means state aid to education for the Omaha, Lincoln, North Platte and Lexington Public Schools and many other Nebraska school districts will be cut. … Cutting funding for the education of Nebraska’s children and increasing taxes on Nebraska’s families are not my priorities. … Reviewing this decision in a detailed, thoughtful and responsible manner will take weeks and months before a complete determination can be made on what this ruling means for Nebraska.â€
Nevada (21%). The state is setting up a health insurance exchange and using funds provided in the law to do so, says Jon Hager, executive director of the Silver State Health Insurance Exchange. Gov. Brian Sandoval, a Republican, “does not intend to automatically accept the Medicaid expansion. We will continue to examine (the ruling) to fully understand its implications,†says Mary-Sarah Kinner, Sandoval’s press secretary.
New Hampshire (10%). Gov. John Lynch, a Democrat, last month signed a law preventing the state from establishing an insurance exchange. That means the state’s exchange will be run by the federal government. Lynch says the law “will help provide access to affordable health care to many more of our citizens and help our small businesses with the high costs of health care. The court’s decision allows those important provisions to go forward.â€
New Jersey (15%). Gov. Chris Christie, a Republican, says, “I still believe this is the wrong approach for the people of New Jersey, who should be able to make their own judgments about health care.†Christie is weighing whether letting the federal government set up the state health insurance exchange would be a less expensive option, he said on Fox News Channel’s Fox and Friends show. He also said he’s not sure the state needs to expand Medicaid under the law because the state’s program for the poor and disabled already is inclusive. He praised one part of the Supreme Court ruling that pulls back the federal government’s ability to force states to expand Medicaid to include people with incomes up to 133% of the poverty level.
New Mexico (21%). The state is developing its own insurance exchange, says Matt Kennicott, communications director for the New Mexico Human Services Department. “There are still a lot of questions that need to be answered and a lot of moving pieces on Medicaid expansion,†Kennicott says.
New York (15%). Gov. Andrew Cuomo, a Democrat, has ordered the establishment of a state-based health exchange aimed at the roughly 2.7 million New Yorkers lacking health insurance. The goal is to be ready to accept applications on Oct. 1, 2013. The state also will expand Medicaid. Regardless of the fall presidential election, Cuomo’s office says, “New York’s planning efforts are focused on implemented the federal law as it stands.â€
North Carolina (18%). The Legislature did not set up a health care exchange before adjourning this year and Gov. Bev Perdue, a Democrat, is reviewing options, says Chris Mackey, Perdue’s deputy communications director. Perdue, who is not running for re-election this year, says it’s up to the Legislature to decide whether to expand Medicaid.
North Dakota (12%). The state is not moving to implement the law. “The health care plan is wrong for North Dakota,†says Gov. Jack Dalrymple, a Republican. “Our citizens want the freedom to make their own decisions about their health-care coverage. Instead of embracing government-run health care supported by a tax on the American people, we should be pursuing market-based reforms that make heath care more affordable, that encourage greater participation and provide Americans with more choices.â€
Ohio (14%). Ohio probably will let the federal government create a health exchange for the state, says Lt. Gov. Mary Taylor, a Republican. She estimates the move would save Ohio $43 million. She called a federal exchange rather than a state-run exchange “the lesser of two evils.†Ohio is reluctant to expand Medicaid but hasn’t ruled it out. John McCarty, state Medicaid director, says Ohio estimates that the health care law will add $369 million to the state’s costs in 2014 even without expanding Medicaid, making the state reluctant to take on any other obligations, even if the federal government promises to pay most of the cost.
Oklahoma (18%). Gov. Mary Fallin, a Republican, plans to wait until after the November election to decide how to proceed, according to local news accounts. The Legislature has declined to establish health care exchanges. Fallin hasn’t decided whether to expand Medicaid coverage to more uninsured adults, mostly at federal expense.
Oregon (17%). The state is on pace to establish its health insurance exchange in 2013, says Tim Raphael, communications director for Gov. John Kitzhaber, a Democrat. The state isn’t waiting for the presidential election to take action. “The governor supports covering the uninsured and changing the way health care is delivered to improve health, provide better care and reduce cost,†Raphael says.
Pennsylvania (11%). Gov. Tom Corbett, a Republican, likely will push the state to set up its own exchange because it can do it better than the federal government, spokeswoman Kelli Roberts says. Corbett has not yet decided whether to expand Medicaid. Corbett said after the ruling that the law will “raise health care costs for our families, our employers and our state†but that he would comply and “do all we can to ensure the negative impact of this law affects the lives of Pennsylvanians as little as possible.†Corbett “hopes that in November we will have a change in leadership and repeal this law, but what we are focused on is making sure we are doing what is right†in complying with the law, she says.
Rhode Island (12%). The state “has already done tremendous work to establish a (state-based) exchange and plan for Medicaid expansion, says the office of Gov. Lincoln Chafee, an independent. “Rhode Island is committed to implementing Medicaid expansion in order to close the coverage gap and reach nearly universal coverage for all Rhode Islanders.â€
South Carolina (19%). Gov. Nikki Haley, a Republican, opposes health care exchanges and expanding Medicaid. “We’re not going to shove more South Carolinians into a broken system that further ties our hands when we know the best way to find South Carolina solutions for South Carolina health problems is through the flexibility that block grants provide,†says Rob Godfrey, the governor’s spokesman. The state plans to delay action until after the November election.
South Dakota (13%). “We will not attempt to set up an exchange before the November election,†says Gov. Dennis Daugaard, a Republican. “I’m not very enthusiastic about expanding Medicaid. In South Dakota, people still believe in self-reliance, and I think able-bodied adults should be self-reliant. … My hope is that, after the election, the next president and congress will repeal this law.â€
Tennessee (15%). Gov. Bill Haslam, a Republican, “firmly believes Obamacare should be repealed because it increases the number of people covered by a broken health care system rather than addressing cost issues,†says Dave Smith, a spokesman. “The state has been doing preliminary planning for health care exchanges. The governor, in addition to advocating for repeal, believes it is the state’s responsibility to be prepared for multiple scenarios†and prefers a state-run exchange.
Texas (25%). Gov. Rick Perry, a Republican, opposes the insurance exchanges and Medicaid expansion, calling them “brazen intrusions into the sovereignty of our state. I stand proudly with the growing chorus of governors who reject the power grab.†Texas has an estimated 6.2 million uninsured residents and the highest rate of uninsured among the states. “Neither a ‘state’ exchange nor the expansion of Medicaid under the Orwellian-named Patient Protection and Affordable Care Act would result in better ‘patient protection’ or in more ‘affordable care,’ †Perry says. “What they would do is make Texas a mere appendage of the federal government when it comes to health care.†Expanding Medicaid as the law envisions “would only exacerbate the failure of the current system and would threaten even Texas with financial ruin,†Perry says, adding that the law’s “unsound encroachments will find no foothold here.â€
Utah (14%). Gov. Gary Herbert, a Republican, says the state may not expand Medicaid. He wants states more involved in setting health care policy. “We have 50 incubators of innovation and policy, who have experience with their own unique circumstances and challenges,†he says. “The federal one-size-fits-all mentality is short-sighted and simply bad policy.†He says the state will run a “consumer-oriented, market-driven exchange.â€
Vermont (9%). Gov. Peter Shumlin, a Democrat, supports meeting the requirements of the law for Medicaid and the health benefit exchange. The state is setting up the exchange on its own, with the help of federal funds. Shumlin supports a government-financed health care system covering every Vermont resident.
Virginia (13%). The state challenged the law in court. But Gov. Bob McDonnell, a Republican, also has said the state would comply with the law and has made plans to set up its own health exchange. “If we have to choose between accepting another new federal bureaucratic monstrosity of a federal health-care exchange vs. a state exchange where we can determine what goes in there — if that’s the Hobson’s choice we are faced with — my inclination is we ought to have a state-based exchange,†McDonnell says. “But I think even a state-based exchange is a bad idea. It’s more bureaucracy.†McDonnell says he worries about the impact of Medicaid expansion on the state’s budget and will push to have the law repealed.
Washington (13%). “Our state has already moved to develop a health care exchange. Our governor also supports the Medicaid expansion,†says Karina Shagren, a spokeswoman for Gov. Chris Gregoire, a Democrat.
West Virginia (14%). “We’re going to review the Supreme Court’s ruling, and work with our federal delegation on how we move forward,†says Gov. Earl Ray Tomblin, a Democrat.
Wisconsin (9%). Gov. Scott Walker, a Republican who joined the lawsuit opposing the law, says “Wisconsin will not take any action to implement Obamacare. I am hopeful that political changes in Washington, D.C., later this year ultimately end the implementation of this law.â€
Wyoming (16%). “There are numerous questions that the federal government will have to answer before we can fully understand the implications of the ruling and the state’s new options for the Medicaid expansion,†says Renny MacKay, a spokesman for Gov. Matthew Mead, a Republican.
Courtesy of USA Today
How each state will approach health care act
Where the states stand on healthcare
Here is a look at where each of the 50 states stand on implementing President Obama’s federal health care law.
Connecticut
Under Gov. Dan Malloy, a Democrat, Connecticut plans to fully implement the health care act and meet all deadlines. The state has hired staff and a board of directors to begin implementing health care exchanges and have them in place by the 2014 deadline set by the federal law. Connecticut already allows people under 26 years old to stay on their parents’ health insurance policies, which is part of the federal law.
New England Region
Maine
The state has passed laws implementing components of the law, such as allowing parents to add coverage of children up to age 26 and outlawing denial of insurance coverage due to pre-existing conditions. Maine has also passed a law that will allow consumers to shop out-of-state for coverage.
Massachusetts
A sweeping health care law was passed in 2006 that became the blueprint for the federal overhaul. Many of the key elements of the federal law, including the “individual mandate†requiring nearly everyone have insurance, remain the law in Massachusetts.
New Hampshire
Currently laws that echo portions of the Affordable Care Act are in place, such as allowing dependent unmarried residents to remain on their parent’s health care insurance until age 26. Gov. John Lynch, a Democrat, last month signed a law preventing the state from establishing an insurance exchange. That means the state’s exchange will be run by the federal government.
Rhode Island
The state has received $58 million in federal funds to assist in the creation of its health benefits exchange. Gov. Lincoln Chafee, an independent, says “the state has already done tremendous work to establish a (state-based) exchange.â€
Vermont
The state is setting up the exchange on its own, with the help of federal funds.
Middle Atlantic Region
New Jersey
The state is weighing whether letting the federal government set up the state health insurance exchange would be a less expensive option. Gov. Chris Christie said he’s not sure New Jersey needs to expand Medicaid under the federal law because the state’s program for the poor and disabled already is inclusive.
New York
Gov. Andrew Cuomo, a Democrat, has ordered the establishment of a state-based health exchange aimed at the roughly 2.7 million New Yorkers lacking health insurance. The state also will expand Medicaid.
Pennsylvania
Republican Gov. Tom Corbett will push the state to set up its own exchange ‘“because it can do it better than the federal government.â€
South Atlantic Region
Delaware
Officials are working on a health care exchange and accepting public input as they come up with minimum coverage requirements that must be included in health care plans for individuals and small businesses. The state is still reviewing its options for Medicaid expansion.
Florida
Republican Gov. Rick Scott ordered the state not to accept federal money for implementing the health care law. Florida has rejected or declined to pursue more than $106 million and has returned $4.5 million. The state has not implemented an exchange that would meet the requirements of the federal law.
Georgia
Georgia has done nothing to implement a health care exchange. Lawmakers have introduced bills that would either allow or hinder implementation of the law, though none have passed. The state is waiting for the outcome of the presidential election.
Maryland
Legislation has passed in Maryland to create a health care exchange, setting up standards and regulations to run the program and creating the framework for a marketplace where individuals and small businesses can purchase coverage.
North Carolina
Legislation aimed at prohibiting the mandate for individuals to buy health insurance was the first item introduced after Republicans took over control of by North Carolina’s General Assembly last year. The Legislature did not set up a health care exchange before adjourning this year and Gov. Bev Perdue, a Democrat, is reviewing options
South Carolina
The state, which is among the states that sued over the constitutionality of the federal health care law, opted not to implement health care exchanges after a panel concluded there were too many unanswered questions. South Carolina is delaying action until after the presidential election.
Virginia
The state has expressed its intent to create a health care exchange, but Republican Gov. Bob McDonnell has not acted on recommendations made by a gubernatorial advisory council. Virginia filed its own lawsuit challenging the health care law, but lost in federal appeals court.
West Virginia
Legislation has been allowing for a state-run health care exchange and the state plans to work with the federal delegation on how to move forward.
East South Central Region
Alabama
Republican Gov. Robert Bentley, a physician, created a commission in 2011 to recommend a plan for a health insurance exchange, but he successfully opposed efforts by some legislators to enact one in May. The state is reviewing the larger implications of the law.
Kentucky
The state will operate its own insurance exchange but has not decided whether to expand Medicaid.
Mississippi
Insurance Commissioner Mike Chaney, a Republican, has been working on a health care exchange and has accepted federal money for the project. The state is moving to establish a free-market health insurance exchange but will not expand Medicaid.
Tennessee
The state has laid the groundwork for a health insurance exchange but prefers a state-run exchange.
East North Central Region
Illinois
The state has received three federal grants to study and start building its health insurance exchange, but the Legislature has failed to pass a law establishing it. Gov. Pat Quinn, a Democrat, has considered an executive order to do that, but now may pursue a federal-state partnership instead.
Indiana
No decision has been made to establish a state-based exchange and the decision to expand Medicaid will be made by the next governor and Legislature.
Michigan
The Department of Licensing and Regulatory Affairs has been working to set up a health insurance exchange but has had limited success because House Republicans refuse to let it use $9.8 million in federal planning dollars. Because of looming federal deadlines to have an exchange in place, state officials are planning for a state-run exchange while also talking to federal officials about a possible partnership on a federal exchange where the state handles just some responsibilities, such as customer service.
Ohio
The state will allow the federal government create a health exchange for the state but is reluctant to expand Medicare.
Wisconsin
The state has not begun setting up its health insurance exchange. Wisconsin does not plan to take any action until after the presidential election.
West North Central Region
Iowa
The state does not have a law establishing a health insurance exchange, and Republican Gov. Terry Branstad says the state has already enacted several pieces of the law, including a website that helps residents find insurance, but the state has yet to comply with other requirements.
Kansas
The Republican-dominated state government has been hostile to the 2010 federal law and hasn’t moved to set up a health care exchange. No decision will be made until after the presidential election.
Minnesota
The state has embraced the health care overhaul more than many states. Democratic Gov. Mark Dayton used a provision in the federal law to extend Medicaid coverage to more than 80,000 vulnerable adults as soon as he took office in 2011. His administration has focused on developing an online health insurance exchange envisioned as a key part of the law, securing $28.4 million from the federal government for Minnesota’s planning efforts.
Missouri
The state received an initial planning grant but has not implemented a health insurance exchange. Missouri is currently reviewing the ruling.
Nebraska
The Legislature in 2011 passed a bill implementing the Silver State Health Insurance Exchange and creating a seven-member board to oversee it. Republican Gov. Brian Sandoval opposes the federal health care law and is reviewing the ruling to understand its implications.
North Dakota
The state is not moving to implement the law because of its cost and complexity.
South Dakota
Republican Gov. Dennis Daugaard has delayed work on setting up a health insurance exchange until after the presidential election.
West South Central Region
Arkansas
The state decided on a federal-state partnership for its health insurance marketplace. Legislators blocked a bill by which the state would have created its own insurance exchange but have since accepted a grant that will allow it to at least have a role in the federally created exchange.
Louisiana
The state has not implemented health care exchanges and is waiting for the results of the presidential election.
Oklahoma
The state has not implemented health care exchanges and is waiting for the results of the presidential election. Oklahoma hasn’t decided whether to expand Medicaid coverage to more uninsured adults.
Texas
The government has not implemented a health care exchange. Texas has joined with other states in challenging the law in court. Gov. Rick Perry, who is vocally opposed to the law, says the state can “deliver health care more efficiently, more effectively and cheaper than the federal government can.â€
Mountain Region
Arizona
The state is among those challenging the constitutionality of the health care overhaul. The lawsuit covers about 22,000 people statewide, including some 14,000 people in the Phoenix area. Republican Gov. Jan Brewer’s administration has made no decision.
Colorado
Lawmakers passed legislation in 2011 to set up health insurance exchanges, and a commission is in the process of implementing them. The exchanges are set to start October 2013.
Idaho
The state has not implemented health insurance exchanges, over objections from insurers including Blue Cross of Idaho. The state is waiting for the results of the presidential election.
Montana
Gov. Brian Schweitzer, a Democrat, says Montana is reviewing the decision.
Nevada
Legislature in 2011 passed a bill implementing the Silver State Health Insurance Exchange and creating a seven-member board to oversee it. Republican Gov. Brian Sandoval opposed the federal health care law as a candidate. The state is setting up a health insurance exchange and using funds provided in the law to do so
New Mexico
The state is developing its own insurance exchange and wants to have the revamped Medicaid program implemented in the fall of 2013.
Utah
The state implemented a health insurance exchange before the federal Affordable Care Act was passed to help small businesses obtain insurance coverage for their employees. Utah is among 26 states that sued the federal government over the law. Utah may not expand Medicaid.
Wyoming
While the state has not implemented health care exchanges, a steering committee is studying an exchange for Wyoming and will present a report to the Legislature this fall.
Pacific Region
Alaska
Among the states that sued over the constitutionality of the federal health care law, Alaska has yet to implement a health care exchange. The health department has hired a consultant to help design one, and that report is expected soon. It may be months before decisions are made on Medicaid expansion and a health care exchange.
California
Parts of legislation are already implemented, including creating the beginnings of health care exchanges to provide consumers a marketplace to purchase insurance policies starting in 2014. The state has also already banned insurers from refusing coverage for children with pre-existing illnesses and young adults are allowed to stay on their parents’ plans through age 26.
Hawaii
The state joined several states last year in filing a friend-of-the-court brief in support of the law. Gov. Neil Abercrombie, a Democrat, said at the time the law preserved the best elements of Hawaii’s long-standing health care statutes. The state also used a $300,000 private grant to create a state job for a coordinator to implement the overhaul. Hawaii plans to develop its own insurance exchange, a key component of the federal overhaul.
Oregon
The state is working aggressively to implement the health care law and is farther along than most other states. The federal government has committed more than $60 million in grants to develop a health insurance exchange that could be duplicated in other states.
Washington
Republican Attorney General Rob McKenna signed on to the health care lawsuit against the wishes of the state’s Democratic governor and majority Democrats, but Washington state moved ahead this past legislative session with implementing its own health insurance exchange.
States are sharply divided on how — or whether — to implement the Patient Protection and Affordable Care Act after it was upheld by the U.S. Supreme Court.
Indiana Gov. Mitch Daniels on how his state will approach the Affordable Care Act: "Absolutely no decision has been made to establish a state-based exchange."
The health care law was enacted in March 2010, but its two major expansions of health coverage don’t begin until January 2014.
One is the creation of health care exchanges — government agencies or non-profit groups that will organize and oversee a private market for buying health insurance. The exchanges will offer a choice of certified health plans from which individuals and small businesses can choose.
States are expected to establish exchanges or create partnerships with the federal government. If states don’t act, a federal exchange is supposed to serve those residents.
In addition, the law calls for a vast expansion of Medicaid, the federal-state health insurance program for the poor and people with disabilities. For the first time in most states, adults earning up to 138% of the federal poverty rate, or $31,809 for a family of four, would be covered.
As passed and signed by President Obama, the law threatened states with the loss of all federal Medicaid funds if they did not expand their programs. The Supreme Court struck down that provision, freeing states to sidestep the expansion without losing other funds.
USA TODAY interviews with governors, top aides and health care officials show some states forging ahead on the law and others are holding back (number in parenthesis is the estimated percentage of people in each state who have no health insurance):
Alabama (16%). “We do not know if the state can afford to expand Medicaid,†says Jennifer Ardis, press secretary for Gov. Robert Bentley, a Republican and a dermatologist. “We have serious concerns about the increased costs associated with expanding entitlement programs, but we need to understand the larger implications of the ruling as a whole to determine how many Alabamians might be subject to the Obamacare tax before deciding the best course of action.â€
Alaska (18%). Gov. Sean Parnell, a Republican, “has directed the state departments of Law and Health and Social Services to review the (court) decision. It may be months before decisions are made on Medicaid expansion and a health care exchange,†says Sharon Leighow, Parnell’s press secretary.
Arizona (19%). “At this point, the governor has made no decision†on the insurance exchange and Medicaid expansion, says Ann Dockendorff, spokeswoman for Gov. Jan Brewer, a Republican. “We are actively planning to see what role an exchange would play in — and how the ruling will impact — Arizona’s health care system.†Brewer says, “It is now up to the American people to save our country from the fiscal and regulatory nightmare known as Obamacare. … If Arizonans are to have access to the health care they need from the provider they choose, Obamacare must be fully repealed.â€
Arkansas (19%). The state will rely on the federal government for an insurance exchange. The state will expand Medicaid services, says Gov. Mike Beebe, a Democrat. “If (working people) have the opportunity to have health care coverage, and if it’s going to be paid for by the federal government … I don’t know how we leave our people out,†he says.
California (19%). The state is “about halfway†toward a Web-based enrollment system to meet the Jan. 1, 2014, deadline for health exchanges, says Diana Dooley, secretary of the state’s Health and Human Services Agency. California will expand Medicaid and is expecting a 10% enrollment increase, Dooley says. But California faces a $15.7 billion budgetary shortfall in the 2012-13 fiscal year, according to state estimates. A more than $8 billion tax hike is on the ballot for voters’ consideration in November to help close the gap. “If that initiative fails in November, we will have to evaluate what impact that will have on our ability to fully implement the (health care) reforms,†Dooley says.
Colorado (14%). The state created a health insurance exchange in 2011, says Lorez Meinhold, senior policy director for Gov. John Hickenlooper, a Democrat. People will be able to begin purchasing insurance in October 2013 for coverage beginning Jan. 1, 2014. “We are creating a Colorado-based system. But we do still need the federal dollars and will go after the federal dollars to build the Colorado exchange,†Meinhold says. The state is not waiting for the election and has already begun using Medicaid to cover some people without insurance.
Connecticut (11%). Under Gov. Dan Malloy, a Democrat, Connecticut plans to fully implement the health care act and meet all deadlines. The state already authorized an insurance exchange and expects to runs its own, says Benjamin Barnes, Connecticut secretary of policy and management. The Medicaid expansion could save the state roughly $300 million a year because the state already voluntarily covers some low-income adults without insurance. The new law will let the state expand coverage of adults from the current 60% of the poverty level — for which the state pays 50% of the cost — to 133% of the poverty level while the federal government pays 100% of the costs for the first three years, Barnes says.
Delaware (12%). “We do not plan a standalone state exchange but have been working … toward a federal partnership exchange,†says Gov. Jack Markell, a Democrat. “We are still reviewing our options on Medicaid expansion and anticipate further guidance†from the federal government.
District of Columbia (12%). The District plans to implement a health insurance exchange by Oct. 1, 2013, and has already expanded Medicaid. “We will continue to move forward with implementation of this landmark legislation for District residents,†says Wayne Turnage, director of the Department of Health Care Finance.
Florida (21%). “Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program,†says Gov. Rick Scott, a Republican. The state also won’t build insurance exchanges. “Florida already has health care safety net programs for those with the greatest need, including Florida KidCare to ensure no child goes without health care in Florida. … But even though the federal government has promised to initially pay 100% of the increase in Medicaid payments for the first three years of Obamacare, the burden increasingly shifts to Florida taxpayers in future years. Medicaid, which has been growing for years 3½ times as fast as Florida’s general revenue, will soon grow even faster under Obamacare, and education funding will be adversely impaired if we do not control the growth in Medicaid spending.â€
Georgia (20%). “It’s far too early to say how we’re going to approach the Medicaid expansion,†says Gov. Nathan Deal, a Republican. “The court changed the rules of the game on expansion and we’ll need to see what the executive branch issues in regulations. … We will wait until the election, which will determine our next steps. However, Obamacare is far too costly for the state with the estimated $4.5 billion in new costs over the next 10 years. … We have to look at the most cost effective ways to increase insurance coverage for Georgians. From the state perspective, it’s unaffordable.â€
Hawaii (8%). “We are planning to fully implement our state-based exchange and the Medicaid expansion,†says Gov. Neil Abercrombie, a Democrat.
Idaho (17%). “Obamacare has been bad for America from the beginning,†says Gov. C.L. “Butch†Otter, a Republican. “Change is now in the hands of the American people and we must elect a new president and congressional candidates who will repeal Obamacare.â€
Illinois (15%). The state will work with the federal government to set up an insurance exchange. The state supports expanding Medicaid. “We’ll move forward to deliver the benefits of the Affordable Care Act to millions of people in Illinois,†says Deputy Gov. Cristal Thomas, a Democrat.
Indiana (14%). “Absolutely no decision has been made to establish a state-based exchange,†says Gov. Mitch Daniels, a Republican. “Before a decision can be made, the state needs more information about how a federally based exchange will operate and be funded. … A Medicaid expansion would put 1 in 4 Hoosiers (approximately 500,000 new enrollees) in Medicaid at a cost of approximately $2 billion over 10 years.†Daniels says a decision on whether to expand Medicaid will be made by the next governor and Legislature.
Iowa (12%). Gov. Terry Branstad, a Republican, joined the lawsuit against the law “because he calculated that it would cost $800 million for 150,000 new Iowans to join the Medicaid rolls, which is something neither Iowa nor the federal government can afford,†says Tim Albrecht, a spokesman. “His goal is to make Iowa the healthiest state in the nation through other methods.â€
Kansas (13%). Gov. Sam Brownback, a Republican, says no decision on expanding Medicaid or creating an insurance exchange will be made until after the November election. “It’s a political question now,†he says.
Kentucky (15%). The state will operate its own insurance exchange but has not decided whether to expand Medicaid, says Kerri Richardson, communications director for Gov. Steven Beshear, a Democrat.
Louisiana (17%). “Come this November, we are going to elect a new president and a new Congress who will repeal and replace Obamacare,†Gov. Bobby Jindal, a Republican, says. “That’s why we have refused to implement the Obamacare health exchange or the Medicaid expansion.â€
Maine (10%). Gov. Paul LePage, a Republican, says the court ruling “has verified what President Obama has refused to admit all along, which is to say this law is an enormous tax on the American people. The federal government can force you to do or buy anything, as long as they call it a ‘tax.’ This massive tax hike will only destroy the American economy as it forces us over the financial cliff. … It is now up to the American people to demand full repeal of Obamacare. The Washington, D.C., elites cannot and should not run our lives.â€
Maryland (13%). Under Gov. Martin O’Malley, a Democrat, the state has “passed legislation to create a health care exchange, setting up standards and regulations to run the program and creating the framework for a marketplace where individuals and small businesses can purchase coverage,†says Raquel Guillory, a spokeswoman for O’Malley. Maryland also supports expanding Medicaid.
Massachusetts (5%). Gov. Deval Patrick, a Democrat, expects Massachusetts to fully adopt the federal law and will have to make only small changes in its existing system of universal health coverage, which the federal law is modeled after. The health insurance exchange must reconcile some differences between the state and federal law by 2014, such as the amount of the penalty for not buying insurance and the income levels that trigger the penalties.
Michigan (13%). No state GOP leaders, including Gov. Rick Snyder, have committed to adding roughly 500,000 uninsured residents to the Medicaid rolls beginning Jan. 1, 2014 — despite a federal pledge to pay the full tab the first two years and ultimately 90% of all costs after that. Even if the federal government ultimately pays 90% of the expanded Medicaid costs, Michigan’s share could run $200 million annually, according to the Senate Fiscal Agency. Sara Wurfel, Snyder’s spokeswoman, says the administration wants to study the cost of expanding Medicaid coverage — in concert with lawmakers — to determine the “best course of action†for the state. State Senate Minority Leader Gretchen Whitmer, D-East Lansing, says she worries that the issue will become mired in a partisan slugfest, perhaps leading the state to miss out on critical federal dollars to help its neediest citizens.
Minnesota (9%). The state will keep planning to develop a health-coverage exchange and to expand Medicaid, says Lucinda Jesson, commissioner of the Minnesota Department of Human Services. Bills have been introduced to create a state exchange, but the GOP-controlled Legislature elected not to pass one. Gov. Mark Dayton, a Democrat, last year extended Medicaid to 84,000 adults earning less than $8,400 a year.
Mississippi (19%). The state is moving to establish a free-market health insurance exchange but will not expand Medicaid, says Gov. Phil Bryant, a Republican. “Even when the expansion is fully funded by the federal government, the state would still have to come up with an additional $110 million in administrative costs to support the 400,000 potential new participants,†Bryant says. “I plan to work with conservatives across the county to elect Mitt Romney, so we can repeal and replace Obamacare.â€
Missouri (14%). “We’re just now beginning to review this ruling so that we can understand exactly what it means for Missouri,†says Gov. Jay Nixon, a Democrat. “This ruling has significant complexities and implications for families, health care providers and insurers.â€
Montana (17%). Gov. Brian Schweitzer, a Democrat, says: “We are reviewing the decision. Unlike the federal government, Montana can’t just print money. We have a budget surplus and we’re going to keep it that way. The federal law means Montana’s Medicaid population will double. … Preliminary estimates … indicate an additional 84,000 people will be eligible for Medicaid here by 2019 — at an estimated cost of more than $1.2 billion by the same year. With Montana’s share of the bill estimated at $71 million, a new approach to controlling health care costs is needed. There are still a lot of unanswered questions.â€
Nebraska (12%). Gov. Dave Heineman, a Republican, says: “My biggest concern is that an unfunded expansion of Medicaid means state aid to education for the Omaha, Lincoln, North Platte and Lexington Public Schools and many other Nebraska school districts will be cut. … Cutting funding for the education of Nebraska’s children and increasing taxes on Nebraska’s families are not my priorities. … Reviewing this decision in a detailed, thoughtful and responsible manner will take weeks and months before a complete determination can be made on what this ruling means for Nebraska.â€
Nevada (21%). The state is setting up a health insurance exchange and using funds provided in the law to do so, says Jon Hager, executive director of the Silver State Health Insurance Exchange. Gov. Brian Sandoval, a Republican, “does not intend to automatically accept the Medicaid expansion. We will continue to examine (the ruling) to fully understand its implications,†says Mary-Sarah Kinner, Sandoval’s press secretary.
New Hampshire (10%). Gov. John Lynch, a Democrat, last month signed a law preventing the state from establishing an insurance exchange. That means the state’s exchange will be run by the federal government. Lynch says the law “will help provide access to affordable health care to many more of our citizens and help our small businesses with the high costs of health care. The court’s decision allows those important provisions to go forward.â€
New Jersey (15%). Gov. Chris Christie, a Republican, says, “I still believe this is the wrong approach for the people of New Jersey, who should be able to make their own judgments about health care.†Christie is weighing whether letting the federal government set up the state health insurance exchange would be a less expensive option, he said on Fox News Channel’s Fox and Friends show. He also said he’s not sure the state needs to expand Medicaid under the law because the state’s program for the poor and disabled already is inclusive. He praised one part of the Supreme Court ruling that pulls back the federal government’s ability to force states to expand Medicaid to include people with incomes up to 133% of the poverty level.
New Mexico (21%). The state is developing its own insurance exchange, says Matt Kennicott, communications director for the New Mexico Human Services Department. “There are still a lot of questions that need to be answered and a lot of moving pieces on Medicaid expansion,†Kennicott says.
New York (15%). Gov. Andrew Cuomo, a Democrat, has ordered the establishment of a state-based health exchange aimed at the roughly 2.7 million New Yorkers lacking health insurance. The goal is to be ready to accept applications on Oct. 1, 2013. The state also will expand Medicaid. Regardless of the fall presidential election, Cuomo’s office says, “New York’s planning efforts are focused on implemented the federal law as it stands.â€
North Carolina (18%). The Legislature did not set up a health care exchange before adjourning this year and Gov. Bev Perdue, a Democrat, is reviewing options, says Chris Mackey, Perdue’s deputy communications director. Perdue, who is not running for re-election this year, says it’s up to the Legislature to decide whether to expand Medicaid.
North Dakota (12%). The state is not moving to implement the law. “The health care plan is wrong for North Dakota,†says Gov. Jack Dalrymple, a Republican. “Our citizens want the freedom to make their own decisions about their health-care coverage. Instead of embracing government-run health care supported by a tax on the American people, we should be pursuing market-based reforms that make heath care more affordable, that encourage greater participation and provide Americans with more choices.â€
Ohio (14%). Ohio probably will let the federal government create a health exchange for the state, says Lt. Gov. Mary Taylor, a Republican. She estimates the move would save Ohio $43 million. She called a federal exchange rather than a state-run exchange “the lesser of two evils.†Ohio is reluctant to expand Medicaid but hasn’t ruled it out. John McCarty, state Medicaid director, says Ohio estimates that the health care law will add $369 million to the state’s costs in 2014 even without expanding Medicaid, making the state reluctant to take on any other obligations, even if the federal government promises to pay most of the cost.
Oklahoma (18%). Gov. Mary Fallin, a Republican, plans to wait until after the November election to decide how to proceed, according to local news accounts. The Legislature has declined to establish health care exchanges. Fallin hasn’t decided whether to expand Medicaid coverage to more uninsured adults, mostly at federal expense.
Oregon (17%). The state is on pace to establish its health insurance exchange in 2013, says Tim Raphael, communications director for Gov. John Kitzhaber, a Democrat. The state isn’t waiting for the presidential election to take action. “The governor supports covering the uninsured and changing the way health care is delivered to improve health, provide better care and reduce cost,†Raphael says.
Pennsylvania (11%). Gov. Tom Corbett, a Republican, likely will push the state to set up its own exchange because it can do it better than the federal government, spokeswoman Kelli Roberts says. Corbett has not yet decided whether to expand Medicaid. Corbett said after the ruling that the law will “raise health care costs for our families, our employers and our state†but that he would comply and “do all we can to ensure the negative impact of this law affects the lives of Pennsylvanians as little as possible.†Corbett “hopes that in November we will have a change in leadership and repeal this law, but what we are focused on is making sure we are doing what is right†in complying with the law, she says.
Rhode Island (12%). The state “has already done tremendous work to establish a (state-based) exchange and plan for Medicaid expansion, says the office of Gov. Lincoln Chafee, an independent. “Rhode Island is committed to implementing Medicaid expansion in order to close the coverage gap and reach nearly universal coverage for all Rhode Islanders.â€
South Carolina (19%). Gov. Nikki Haley, a Republican, opposes health care exchanges and expanding Medicaid. “We’re not going to shove more South Carolinians into a broken system that further ties our hands when we know the best way to find South Carolina solutions for South Carolina health problems is through the flexibility that block grants provide,†says Rob Godfrey, the governor’s spokesman. The state plans to delay action until after the November election.
South Dakota (13%). “We will not attempt to set up an exchange before the November election,†says Gov. Dennis Daugaard, a Republican. “I’m not very enthusiastic about expanding Medicaid. In South Dakota, people still believe in self-reliance, and I think able-bodied adults should be self-reliant. … My hope is that, after the election, the next president and congress will repeal this law.â€
Tennessee (15%). Gov. Bill Haslam, a Republican, “firmly believes Obamacare should be repealed because it increases the number of people covered by a broken health care system rather than addressing cost issues,†says Dave Smith, a spokesman. “The state has been doing preliminary planning for health care exchanges. The governor, in addition to advocating for repeal, believes it is the state’s responsibility to be prepared for multiple scenarios†and prefers a state-run exchange.
Texas (25%). Gov. Rick Perry, a Republican, opposes the insurance exchanges and Medicaid expansion, calling them “brazen intrusions into the sovereignty of our state. I stand proudly with the growing chorus of governors who reject the power grab.†Texas has an estimated 6.2 million uninsured residents and the highest rate of uninsured among the states. “Neither a ‘state’ exchange nor the expansion of Medicaid under the Orwellian-named Patient Protection and Affordable Care Act would result in better ‘patient protection’ or in more ‘affordable care,’ †Perry says. “What they would do is make Texas a mere appendage of the federal government when it comes to health care.†Expanding Medicaid as the law envisions “would only exacerbate the failure of the current system and would threaten even Texas with financial ruin,†Perry says, adding that the law’s “unsound encroachments will find no foothold here.â€
Utah (14%). Gov. Gary Herbert, a Republican, says the state may not expand Medicaid. He wants states more involved in setting health care policy. “We have 50 incubators of innovation and policy, who have experience with their own unique circumstances and challenges,†he says. “The federal one-size-fits-all mentality is short-sighted and simply bad policy.†He says the state will run a “consumer-oriented, market-driven exchange.â€
Vermont (9%). Gov. Peter Shumlin, a Democrat, supports meeting the requirements of the law for Medicaid and the health benefit exchange. The state is setting up the exchange on its own, with the help of federal funds. Shumlin supports a government-financed health care system covering every Vermont resident.
Virginia (13%). The state challenged the law in court. But Gov. Bob McDonnell, a Republican, also has said the state would comply with the law and has made plans to set up its own health exchange. “If we have to choose between accepting another new federal bureaucratic monstrosity of a federal health-care exchange vs. a state exchange where we can determine what goes in there — if that’s the Hobson’s choice we are faced with — my inclination is we ought to have a state-based exchange,†McDonnell says. “But I think even a state-based exchange is a bad idea. It’s more bureaucracy.†McDonnell says he worries about the impact of Medicaid expansion on the state’s budget and will push to have the law repealed.
Washington (13%). “Our state has already moved to develop a health care exchange. Our governor also supports the Medicaid expansion,†says Karina Shagren, a spokeswoman for Gov. Chris Gregoire, a Democrat.
West Virginia (14%). “We’re going to review the Supreme Court’s ruling, and work with our federal delegation on how we move forward,†says Gov. Earl Ray Tomblin, a Democrat.
Wisconsin (9%). Gov. Scott Walker, a Republican who joined the lawsuit opposing the law, says “Wisconsin will not take any action to implement Obamacare. I am hopeful that political changes in Washington, D.C., later this year ultimately end the implementation of this law.â€
Wyoming (16%). “There are numerous questions that the federal government will have to answer before we can fully understand the implications of the ruling and the state’s new options for the Medicaid expansion,†says Renny MacKay, a spokesman for Gov. Matthew Mead, a Republican.
