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State-by-State Decisions on Health Insurance Exchanges: 50 Statistics on Plans for 2014

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Late last week, HHS Secretary Kathleen Sebelius announced that state governors must declare to HHS how they plan to comply with the Affordable Care Act's state exchange requirement by November 16. States that plan to establish their own exchanges now have until December 14 to submit a detailed plan, known as a "blueprint," for how they intend to implement the exchange. HHS will then approve or conditionally approve the state-based exchanges by the statutory deadline of Jan. 1, 2013. In states that choose not to submit state-run exchanges, the federal government will step in and run the state's exchange.

States have the option of establishing the exchange as part of an existing state agency or office, as an independent public agency, or as a non-profit entity. They also have flexibility in determining the role of the exchange with respect to contracting with health plans. All exchanges must contract only with health plans that meet federal requirements for qualified health plans. They can choose to have the exchange contract with all qualified health plans (clearinghouse) or with selected health plans (active purchaser).

Default to federal exchange

States that default to federal exchange have indicated that they will default to a federally-facilitated exchange rather than planning their own model.

1. North Dakota
2. South Dakota
3. Wyoming
4. Nebraska
5. Kansas
6. Texas
7. Missouri
8. Wisconsin
9. Louisiana
10. Alabama
11. Georgia
12. South Carolina
13. New Hampshire
14. Maine
15. Alaska

Planning for partnership exchange

These states have indicated they will partner with the federal government to operate an exchange.

1. Arkansas
2. Illinois
3. Michigan
4. Ohio
5. North Carolina
6. Delaware

Declared state-based exchange

These states have declared their intentions to establish their own insurance exchanges. "Active purchaser" means that the state will set up the exchange contract with selected health plans and/or negotiate premium prices with health plans. "Clearinghouse" means the state will set up the exchange contract with all qualified health plans. States with no indication either way have not addressed the issue yet.

1. Washington
2. Oregon (Active purchaser)
3. California (Active purchaser)
4. Nevada (Clearinghouse)
5. New Mexico
6. Colorado (Clearinghouse)
7. Minnesota
8. Kentucky
9. Mississippi
10. New York
11. Vermont (Active purchaser)
12. Connecticut (Active purchaser)
13. Rhode Island (Active purchaser)
14. Massachusetts (Active purchaser)
15. Maryland (Clearinghouse)
17. Hawaii (Clearinghouse)

Undecided

These states have not yet indicated whether they will operate a state-based exchange or state-federal partnership exchange, or default to federally-facilitated exchange.

1. Montana
2. Idaho
3. Utah
4. Arizona
5. Iowa
6. Oklahoma
7. Indiana
8. Tennessee
9. Florida
10. West Virginia
11. Virginia
12. Pennsylvania
13. New Jersey

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