how states are implementing key affordable care act provisions

7/27/2019 How States are Implementing Key Affordable Care Act Provisions

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The federal health care reform law en-

visioned each state would operate its own

health insurance exchange, a marketplace for

uninsured individuals and small employers

to purchase health insurance. Only 17 states,

however, declared they would do so. Another

seven states took the federal government offer

to operate an exchange in partnership. That left

26 states where, by default, the exchanges will

be operated by the federal government.

These exchanges will begin to offer insurance

for purchase Oct. 1, 2013. For individuals with

incomes below 400 percent of the federal pov-

erty levels, federal subsidies will be available to

make insurance premiums affordable. Coverage

is slated to begin Jan. 1, 2014.

The second major provision of the law

requiring state action is the expansion of

Medicaid eligibility to 138 percent of the

federal poverty level. The Supreme Court,

while declaring the act constitutional in June

2012, ruled that states could not be forced to

expand Medicaid eligibility Jan. 1, 2014, as the

law initially required. The federal government

will fund 100 percent of Medicaid coverage

for these newly eligible people for the first

two years, then drop the funding to 95 percent

in 2017 and to 90 percent after 2020.

Since the courts ruling, governors and

legislatures have wrestled with the question

of whether to expand their states Medicaid

programs. To date, 24 states are moving for-

ward with expansion; another 21 are not. Six

states are sti ll considering expansion. These

decisions have been made through various

combinations of executive and legislative

branch actions.

How States Are Implementing Key Aordable Care Act Provisions

Medicaid Expansion

n Debates Ongoing (as ofJuly 2013)

n Yes

n Not at this Time

Health Exchanges

State

Partnership

Federal Operation

KEY

States Actions on ACA Health Insurance Exchanges and Medicaid Expansion

TH E COUN CI L OF STAT E GOVE RN ME NT S JULY 2013

Debra Miller, CSG Directo r of Health Policy | [email protected],Nancy Coleman, CSG-West Health Committee Coordinator | [email protected]


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Uninsured Adults with Incomes

below 138% Federal Poverty Level4

Current Medicaid Eligibility for Working Adults

(percent federal poverty level) 5

StateHealth

Insurance Exchange1Medicaid

Expansion2Legislative/Executive Action onMedicaid Expansion3 Newly Eligible 133%) NA

New York State-Based Yes Legislation signed into law 170,000 641,000 150% 100%

Pennslyvania Federal Debate ongoingBill authorizing expansion passed by one

legislative body520,000 92,000 58% NA

Rhode Island State-Based YesLegislation to expand passed both

legislative bodies38,000 13,000 181% NA

Vermont State-Based Yes New eligibility levels already covered


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(percent federal poverty level)5

StateHealth


Expansion2Legislative/Executive Action onMedicaid Expansion3 Newly Eligible


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StateHealth




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StateHealth



how states are implementing key affordable care act provisions

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