The State of State-Level Health Insurance Exchanges

Last week the White House released a report on the progress of state-level health insurance exchanges. The report took an exceptionally favorable view of the headway being made by states creating their online insurance marketplaces, and, in truth, was a bit misleading. The Administration claimed that there are currently 28 states making great progress in establishing an exchange. Even if that were true, it still indicates that 22 states, or about 40 percent, are not complying with the Patient Protection and Affordable Care Act (PPACA).

Although the report does not specifically lie, it also does not quite paint an accurate picture. The Administration chose to favorably count any state that falls into a grey area as making progress. Many states have refrained from any legislative activity or the state legislature has merely set up a committee to “study options”. What this really indicates is that many states are purposefully not complying with PPACA, but managing not to violate it either, at least until the January 2014 deadline.

Additionally, as the economic crisis continues, unemployment remains high and PPACA is about to be heard by the Supreme Court, the number of states rejecting the idea of setting up an exchange continues to grow. Just last week, Governor Scott Walker of Wisconsin announced that his state would be joining the likes of Louisiana, Kansas and Florida in refusing to set up an exchange. He further said that Wisconsin would be giving back the $1 million Early Innovator Grant the federal government had given.

Regardless, whether states are stalling on setting up state-level exchanges, “studying” alternative options and costs, or flat out rejecting the idea, it’s safe to say that the optimism shown by the White House report is not an accurate portrait of the state of state-level health insurance exchanges.