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Split down the middle on health insurance exchanges

February 20, 2013
by Alison Knopf, Contributing Writer
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Half the states default to “federal” option, other half to run state-based or partnership exchanges. Will these be done by October 1?

This week, the final count of states running their own health insurance changes came in. Half of the states will not run their own health insurance exchanges; instead the federal government will run the exchanges for them or in partnership with them. Three big states - New Jersey, Ohio, and Florida - were the last states to reject the idea of running their own exchanges before the deadline February 14. 

For patients, it doesn’t really make a difference whether the state or the federal government runs the exchange, but for employers and insurance companies, state assistance would have been welcome, especially in states where those interest groups feel they have more power than they have with the federal government. The exchanges will be open for business on the internet on October 1.

Under the Affordable Care Act (ACA), states must set up health insurance exchanges, where people whose incomes are between 137-400 percent of federal poverty level and who do not get health insurance through their employer will be purchasing health insurance plans. The operation of the health insurance exchanges will be financed with a tax on the premiums for the plans offered on each exchange.

Exchanges:  State-by-state breakdown


Seventeen states, plus the District of Columbia, have received “conditional approval” to operate their own insurance exchanges:


California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont and Washington (and District of Columbia).


Eight states which will operate exchanges in partnership with the federal government:

Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire, South Dakota and West Virginia.

And, the 25 remaining states, many of whom have Republican governors, refused the option to run their own exchanges or partner with the federal governmnet. They will, by default, accept an insurance exchange model that is offered by the federal government. These states include: 

Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Wisconsin and Wyoming.