Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types





Update: State Action Round-Up on Affordable Care Act Implementation

  • Tracy Garber

    Senior Analyst, Manatt Health Solutions

  • Sara Collins
    Sara R. Collins

    Senior Scholar, Vice President, Health Care Coverage and Access & Tracking Health System Performance, The Commonwealth Fund

  • Tracy Garber

    Senior Analyst, Manatt Health Solutions

  • Sara Collins
    Sara R. Collins

    Senior Scholar, Vice President, Health Care Coverage and Access & Tracking Health System Performance, The Commonwealth Fund

In less than five months, the major health insurance provisions of the Affordable Care Act will go into effect. This is the fourth post in a series that offers an overview of action on the new state health insurance marketplaces, or exchanges, and expansion in eligibility for the Medicaid program.

Insurance Marketplace Updates

Beginning on October 1, 2013, Americans who do not have affordable health benefits through a job will be able to go to a new health insurance marketplace in their state and enroll in a private health plan. Adults with annual incomes up to 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four) will be eligible for premium tax credits to help reduce the cost of coverage. In most states, companies with 50 or fewer employees will also be able to select plans through their state’s small-business marketplaces.

Currently, 16 states and the District of Columbia intend to operate a state-based marketplace, while the remaining 34 states will have a federally facilitated marketplace. Seven of these 34 states will conduct plan management activities and/or consumer assistance and outreach functions in a state–federal partnership model. Another seven of the 34 will conduct plan management activities only, and one, Utah, will operate the small-business marketplace while the federal government operates the individual marketplace.

Here is a list of recent state and federal activity.

Action on state-based marketplaces

  • California’s marketplace has decided not to post quality data on health plans in 2014, and instead will begin posting the data in 2015. The federal requirement to post quality data begins in 2016.
    • Ventura County Health Care Plan has rescinded its application to sell in California’s marketplace for the first year, bringing the total number of insurers participating to 12.
  • Colorado has begun its campaign to raise awareness and promote enrollment in the marketplace.
    • Colorado has approved eight insurers to sell plans on the individual marketplace and three to sell plans on the small-group marketplace; premiums vary by geographic area.
    • Insurers selling through the individual market are: All Savers; Colorado Health Insurance Cooperative; Denver Health Medical Plan; HMO Colorado Inc. (Anthem); Humana Health Plan; Kaiser Foundation Health Plan; New Health Ventures; and Rocky Mountain HMO
    • Approved premiums for the individual marketplace.
    • Insurers selling through the small-group market are: HMO Colorado Inc. (Anthem); Kaiser Foundation Health Plan; and Rocky Mountain Hospital and Medical Services (Anthem).
    • Approved premiums for the small-group marketplace.
    • Average premiums for individual and small-group plans by metal tier.
  • Connecticut has approved final rates for 2014 for Anthem, ConnectiCare Benefits, and HealthyCT. Aetna withdrew its plans after approval was announced. Final rate filings can be found here:
  • The District of Columbia’s marketplace has awarded $6.4 million in grants to 35 community groups to train in-person assisters for enrollment.
  • Hawaii has awarded funds to 34 community organizations to assist with consumer enrollment.
  • Idaho plans to have a website up and running and a name for the state’s marketplace by mid-August. 
  • Maryland has opened a call center to help with general questions about health plans and to prepare callers for enrollment. It will provide enrollment assistance starting October 1.
    • Aetna has rescinded its submission to sell plans (including those by Coventry Health Care, which is owned by Aetna) in Maryland’s individual marketplace. 
  • In New Hampshire, Anthem BCBS will sell plans on thestate’s marketplace. Harvard Pilgrim Health Care also expects to sell plans on the marketplace beginning January 2015. 
  • New Mexico has released proposed premium rates.
  • Oregon’s state marketplace will be open for enrollment, with assistance from navigators and community assistors, on October 1, but online enrollment without assistance will not be available until mid-October. 
  • Rhode Island is investing in consumer outreach to increase awareness about the marketplace, including in tents at farmer’s markets. 
  • Twenty-six health plans have been submitted to be sold on Vermont’s marketplace

Action on federally facilitated and partnership marketplaces:

  • Towers Watson has contracted with the Centers for Medicare and Medicaid Services (CMS) to assist employers with enrolling employees, including seasonal and part-time workers, and retirees, into health plans in federally facilitated marketplaces. 
  • The U.S. Department of Health and Human Services has awarded a total of $67 million in grants to 105 organizations to fund navigators in federally facilitated and state partnership marketplaces.
  • The Georgia insurance commissioner requested an additional 30 days to review proposed rates from insurance companies, citing potentially high premium increases.
    • Aetna and Coventry have withdrawn their submissions to sell on Georgia’s exchange.
    • Georgia was not granted a 30-day extension to approve proposed rates. The Insurance Commissioner approved insurers to sell plans on the state’s federally facilitated marketplace.
  • The President and CEO of Louisiana’s Blue Cross Blue Shield estimates that about one-third of beneficiaries will see an increase in premiums, but that the majority of beneficiaries will see increases on trend with past years or will see premiums go down.
  • Maine has posted proposed rates from insurers that have applied to sell on Maine’s federally facilitated individual marketplace. Rates will be approved by CMS before they are considered final.
  • Nonprofit, community-based organizations and foundations are working to inform people and businesses in Missouri about the federally facilitated health insurance marketplace set to open October 1.
  • Blue Cross Blue Shield in North Carolina is setting up a handful of storefronts across the state to reach out to potential enrollees.
  • Ohio has approved 12 insurers to sell 200 plans in the federally facilitated individual marketplace, and six insurers to sell 184 plans in the small business marketplace.
  • In Wisconsin, 13 insurers have applied to sell plans on the state’s individual marketplace and nine have applied to sell on the state’s small-business marketplace.

Medicaid Expansion Updates
The Affordable Care Act set a new income eligibility floor for Medicaid, expanding the program to cover all legal U.S. residents beginning in 2014 with incomes up to 138 percent of the federal poverty level ($15,856 for an individual and $32,499 for a family of four).

In June 2012 the Supreme Court ruled that states’ participation in the Medicaid expansion was optional. A state may choose not to participate, forgoing the influx of new federal funds, but still maintain its traditional Medicaid program.

As of August 16, 2013, 21 states and the District of Columbia have indicated that they intend to expand Medicaid as it was written in the law; four states are pursuing or expressed an interest in a variation on the expansion; 21 states have indicated they will not participate; and four states remain undecided.

These updates highlight recent state-level action.

  • Arkansas’ waiver to use federal Medicaid expansion funds to support individuals purchasing coverage through the state’s marketplace has been officially submitted to CMS.
  • Iowa will submit two waivers to CMS, one to cover people with incomes up to 100 percent of poverty through Medicaid (called the Iowa Wellness Plan) and one to offer premium assistance to people with incomes between 100 percent and 133 percent of poverty to buy insurance through the Iowa marketplace (called the Iowa Marketplace Choice Plan). Together, this plan to cover low- income residents is called the Iowa Health and Wellness Plan.
  • In Utah, a workgroup is developing alternatives to Medicaid expansion, ranging from partial expansion, with some individuals getting insurance through the state’s marketplace, to developing a charity network to provide coverage and care.

Latest Federal Rules, Notices, and Guidance on Affordable Care Act Implementation

Publication Details



T. Garber and S. R. Collins, State Round-Up on Affordable Care Act Implementation, The Commonwealth Fund Blog, August 2013.