Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Five States Won't Implement Health Care Law or Review Insurers

By Rebecca Adams, CQ HealthBeat Associate Editor

January 31, 2014 -- Five states have refused to implement or enforce the health care law, according to a new state-by-state analysis of actions across the country by the nonpartisan Commonwealth Fund.

The 21-page report examined state activities through Nov. 1, 2013 and found that 32 states and the District of Columbia have taken some regulatory or legislative step to carry out the law. But Alabama, Missouri, Oklahoma, Texas and Wyoming have said they will not scrutinize insurers in their states to make sure that they comply with the law and will do nothing to implement it.

States sometimes manage different parts of the law in very different ways, the study found. Maine, South Dakota, and Virginia declined to run their own insurance marketplaces and have not expanded Medicaid, but those states have been among the best in the nation in implementing health insurance market changes such as a ban on preexisting coverage denials or ensuring that insurance companies provide a minimum level of health benefits.

The study called attention to the states which have done the most to implement the health care law’s major components. They are California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, New York, Oregon, Vermont, and the District of Columbia. Each has set up its own insurance marketplaces, expanded Medicaid coverage and enacted all, or nearly all, of the insurance market changes to ensure that consumers benefit from the law.

However, those states have had a mixed record of success, with some such as Oregon and Maryland beset by technical problems with their websites.

“State actions will play an important role in determining whether the law achieves its goals,” said Commonwealth Fund President David Blumenthal.

Rebecca Adams can be reached at [email protected].

Publication Details