Where states stand on implementing health care law

Associated Press Published: June 28, 2012
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WHERE THE STATE STANDS: Minnesota has embraced the health care overhaul more than many states. Democratic Gov. Mark Dayton used a provision in the federal law to extend Medicaid coverage to more than 80,000 vulnerable adults as soon as he took office in 2011. His administration has focused on developing an online health insurance exchange envisioned as a key part of the law, securing $28.4 million from the federal government for Minnesota's planning efforts.

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MISSISSIPPI

NUMBER OF UNINSURED: 618,000 state residents are uninsured, or about 21 percent.

WHERE THE STATE STANDS: Mississippi Insurance Commissioner Mike Chaney, a Republican, has been working on a health care exchange and has accepted federal money for the project. The exchange originally was proposed by Republican Haley Barbour when he was governor.

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MISSOURI

NUMBER OF UNINSURED: 835,000 state residents are uninsured, or about 14 percent.

WHERE THE STATE STANDS: Missouri received an initial planning grant but has not implemented a health insurance exchange because of opposition to it by some Republican state senators.

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MONTANA

NUMBER OF UNINSURED: 176,000 state residents are uninsured, or about 18.1 percent.

WHERE THE STATE STANDS: Republican lawmakers in Montana who controlled the Legislature rejected any efforts to establish a health insurance exchange.

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NEBRASKA

NUMBER OF UNINSURED: 237,000 Nebraska residents are uninsured, about 13 percent of the population.

WHERE THE STATE STANDS: The state does not have a law establishing a health insurance exchange. However, Republican Gov. Dave Heineman has instructed the state Department of Insurance to plan for one in case the law is upheld.

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NEVADA

NUMBER OF UNINSURED: 563,000, or about 21 percent.

WHERE THE STATE STANDS NOW: The Nevada Legislature in 2011 passed a bill implementing the Silver State Health Insurance Exchange and creating a seven-member board to oversee it. Republican Gov. Brian Sandoval opposed the federal health care law as a candidate. He also allowed a private attorney appointed by former Gov. Jim Gibbons to continue representing Nevada in the lawsuit filed by more than two dozen states challenging the law. State officials estimate the Affordable Care Act would cost Nevada $575 million in the first five years as more people become eligible for Medicaid.

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NEW HAMPSHIRE

NUMBER OF UNINSURED: 134,000 state residents are uninsured, or just more than 10 percent.

WHERE THE STATE STANDS: New Hampshire currently has laws that echo portions of the Affordable Care Act, such as allowing dependent unmarried residents to remain on their parent's health care insurance until age 26. Last year, state legislators passed laws that said residents cannot be required to obtain health insurance or be fined for not being covered. They also established a state oversight committee that must give its OK before the federal law is implemented. Democratic Gov. John Lynch's office said it has done some work on implementing aspects of the Affordable Care Act, but has put plans on hold until the U.S. Supreme Court makes its ruling.

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NEW JERSEY

NUMBER OF UNINSURED: 1.3 million, or about 15 percent.

WHERE THE STATE STANDS: The Legislature passed a law to set up a state health insurance exchange, but Republican Gov. Chris Christie vetoed the measure in May, saying he did not want to spend money on something that could be ruled unconstitutional.

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NEW MEXICO

NUMBER OF UNINSURED: 433,000, or about 21 percent.

WHERE THE STATE STANDS: New Mexico this week announced formation of a task force to develop a proposal for creating a state health insurance exchange. Republican Gov. Susana Martinez's administration is also working on an overhaul of Medicaid to try to slow the growth of the program without cutting enrollment or changing who's eligible to receive medical services. The state wants to have the revamped Medicaid program implemented in the fall of 2013.

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NEW YORK

NUMBER OF UNINSURED: 2,886,000 state residents are uninsured, or about 15 percent.

WHERE THE STATE STANDS: Democratic Gov. Andrew Cuomo issued an executive order April 12 to establish a statewide health insurance exchange, where individuals and small businesses could tap up to $2.6 billion in federal tax credits and subsidies, planning to show by January that the state is ready to participate, start taking applications the following October and start operating Jan. 1, 2014.

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NORTH CAROLINA

NUMBER OF UNINSURED: 1.57 million state residents are uninsured, or about 17 percent.

WHERE THE STATE STANDS: Legislation aimed at prohibiting the mandate for individuals to buy health insurance was the first item introduced after Republicans took over control of by North Carolina's General Assembly last year. Lawmakers haven't been able to overcome Democratic Gov. Beverly Perdue's veto of their bill. But work to design health care exchanges has stalled since last summer.

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NORTH DAKOTA

NUMBER OF UNINSURED: 83,000 North Dakota residents, or about 13 percent, had no health insurance in 2010.

WHERE THE STATE STANDS: Legislators rejected a state-run health insurance exchange last year. Majority Republicans said it was too complex and too expensive and to do so would be tantamount to accepting the federal health care overhaul.

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OHIO

NUMBER OF UNINSURED: More than 1.5 million state residents are uninsured, or about 14 percent.

WHERE THE STATE STANDS: Ohio has not moved to create a health care exchange but is evaluating its options. It received a $1 million federal exchange planning grant in 2010. Republican Gov. John Kasich's administration has taken advantage of some parts of the new law to expand coordinated care and propose changes to Medicaid eligibility. Democrats have unsuccessfully pushed bills in the Legislature to set up a state-run exchange. But Lt. Gov. Mary Taylor, who is also Ohio's insurance director, frequently criticizes the overhaul and says it's premature to plan for an exchange without further clarification from the federal government.

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OKLAHOMA

NUMBER OF UNINSURED: About 624,480 Oklahomans are uninsured, or about 17 percent of the state's population.

WHERE THE STATE STANDS NOW: Oklahoma lawmakers first rejected $54 million in federal funding to create a health care exchange and then decided to take no action on developing an exchange, deciding instead to wait and see whether the law is upheld by the U.S. Supreme Court.

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OREGON

NUMBER OF UNINSURED: 612,000 state residents are uninsured, or about 16 percent.

WHERE THE STATE STANDS: Oregon is working aggressively to implement the health care law and is farther along than most other states. The federal government has committed more than $60 million in grants to develop a health insurance exchange that could be duplicated in other states.

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PENNSYLVANIA

NUMBER OF UNINSURED: 1.37 million state residents are uninsured, or about 11 percent.

WHERE THE STATE STANDS: Republican Gov. Tom Corbett, as state attorney general in 2010, joined a group of state officials in challenging the law. Still, Pennsylvania is working to set up a health insurance exchange required by the law, although the state Insurance Department says it is waiting for the Supreme Court's decision before it touches a $33 million grant it won in January to build out the exchange.

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RHODE ISLAND

NUMBER OF UNINSURED: 119,000 state residents are uninsured or about 11.4 percent.

WHERE THE STATE STANDS: Rhode Island has received $58 million in federal funds to assist in the creation of its health benefits exchange. Gov. Lincoln Chafee, an independent, last week picked a former state health official to direct the exchange.

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SOUTH CAROLINA

NUMBER OF UNINSURED: 930,000 state residents are uninsured, or more than 20 percent.

WHERE THE STATE STANDS: South Carolina, which is among the states that sued over the constitutionality of the federal health care law, opted not to implement health care exchanges after a panel concluded there were too many unanswered questions.

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SOUTH DAKOTA

NUMBER OF UNINSURED: Federal officials estimate 105,000 state residents are uninsured, or about 13 percent; South Dakota officials say state survey data is lower, about 9 percent.

WHERE THE STATE STANDS: Republican Gov. Dennis Daugaard has delayed work on setting up a health insurance exchange until the Supreme Court's decision.

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TENNESSEE

NUMBER OF UNINSURED: About 930,000 people, or 15 percent.

WHERE THE STATE STANDS: Tennessee has laid the groundwork for a health insurance exchange but would have to wait until the Legislature returns in January to complete it.

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TEXAS

NUMBER OF UNINSURED: About 6.2 million, or about 25 percent.

WHERE THE STATE STANDS: Texas has not implemented a health care exchange. Texas has joined with other states in challenging the law in court. Gov. Rick Perry, who is vocally opposed to the law, says the state can "deliver health care more efficiently, more effectively and cheaper than the federal government can."

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UTAH

NUMBER OF UNINSURED: 386,000 state residents are uninsured, or nearly 14 percent.

WHERE THE STATE STANDS: Utah implemented a health insurance exchange before the federal Affordable Care Act was passed to help small businesses obtain insurance coverage for their employees. Utah is among 26 states that sued the federal government over the law. Republican Gov. Gary Herbert has criticized the individual mandate and the expansion of Medicaid rolls that administration officials say would cost the state hundreds of millions of dollars.

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VERMONT

NUMBER OF UNINSURED: 59,000 state residents are uninsured, or about 9.5 percent.

WHERE THE STATE STANDS: Vermont in 2011 passed legislation to use the insurance exchange called for under the federal health care law as a springboard to launch a statewide, universal, publicly funded health care system by 2017.

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VIRGINIA

NUMBER OF UNINSURED: Nearly 1.1 million state residents are uninsured, or about 14 percent.

WHERE THE STATE STANDS: Virginia has expressed its intent to create a health care exchange, but Republican Gov. Bob McDonnell has not acted on recommendations made by a gubernatorial advisory council. Virginia filed its own lawsuit challenging the health care law, but lost in federal appeals court.

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WASHINGTON

NUMBER OF UNINSURED: 927,000 state residents are uninsured, or about 13.8 percent

WHERE THE STATE STANDS: Republican Attorney General Rob McKenna signed on to the health care lawsuit against the wishes of the state's Democratic governor and majority Democrats, but Washington state moved ahead this past legislative session with implementing its own health insurance exchange.

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WEST VIRGINIA

NUMBER OF UNINSURED: 244,000 West Virginians are uninsured, or about 13.5 percent.

WHERE THE STATE STANDS: West Virginia has enacted legislation allowing for a state-run health care exchange, but the state has slowed the pace of setting it up to see how the Supreme Court rules.

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WISCONSIN

NUMBER OF UNINSURED: 526,000 state residents are uninsured, or about 9 percent.

WHERE THE STATE STANDS: Wisconsin has not begun setting up its health insurance exchange. Work on that was put on hold in January by Republican Gov. Scott Walker, who wanted to await the Supreme Court's decision.

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WYOMING

NUMBER OF UNINSURED: 93,000 state residents are uninsured, or about 17 percent.

WHERE THE STATE STANDS: Wyoming has not implemented health care exchanges, but a steering committee is studying an exchange for Wyoming and will present a report to the Legislature this fall.