Exchange Implementation Work Underway Across the Country – Say Ahhh! A Children’s Health Policy Blog

Don’t believe everything you read in the newspaper — while
the national media has reported that states are moving “gingerly” to implement
the Affordable Care Act,
in fact there’s been a great deal of activity of late, especially around
exchanges.  No fewer than 16 state
legislatures have acted favorably on measures that contribute to exchange
implementation.  Here’s where we
stand today:

  • In seven states, exchanges are now state law.  California, Colorado, Hawaii, Maryland,
    Vermont, Washington, and West Virginia have enacted exchange legislation and
    created governing structures
  • Connecticut, Nevada, and Oregon are right
    behind–legislatures in these three states have sent exchange bills to their
    governors’ desks
  • Two more states–North Dakota and Virginia–have enacted
    legislation (with Republican governors’ signatures) declaring that they will
    set up exchanges, with the governance details to be worked out later
  • In Illinois, Mississippi, Utah, and Wyoming,
    legislatures voted to move forward with a study of the issues around exchanges
  • A number of other legislatures are actively debating
    exchange bills, such as in Rhode Island and New York
  • And, of course, Massachusetts and Utah have exchanges
    that pre-date the Affordable Care Act–they’ll each need to make some changes to
    align their efforts with the ACA, but they’re several steps down the path

Even before exchange laws are on the books, in many
states agency staff, commissions, work groups, or task forces are deep into the
process of planning exchanges. 
Forty-nine states and DC received the first round of Exchange Planning
Grants under the ACA (Alaska is the only state that has not).   Already, Indiana, Rhode Island,
and Washington have received multi-million dollar grants to take their exchange
planning to the next level with Establishment Grants.  And six states–Kansas, Maryland, New York, Oregon, and
Wisconsin and a consortium of New England states led by Massachusetts, –have
received even larger awards to take the lead in developing technology to power
the exchanges.  These states have
chosen to be Early Innovators who will develop new systems that can be shared
with other states.  Oklahoma was
also awarded an Early Innovator grant but has announced that it will not
proceed with the project.  

In addition to this funding activity, the National
Conference of State Legislatures reports that 31 states, DC, and the Virgin
Islands have convened one or more groups to study and report on the ACA, so
there are a lot of good minds at work in the states making exchange plans.

The law is not yet 15 months old, and we’ve got another
18 months before the January 1, 2013 date when the Secretary of HHS must
determine whether states are on track for having an operational exchange by
2014.  There’s still a lot of work
to do to make sure fully-functioning exchanges are available for every American
who qualifies, but the progress so far is real.  And we certainly look forward to seeing it accelerate in the
next year and a half as dedicated advocates and state officials build this
important new coverage source.    

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