WASHINGTON (AP) —This is the year that will make or break the Patient Protection and Affordable Care Act of 2010 (PPACA).
States will either move forward with implementing major health insurance changes that are supposed to take effect in 2014, or the changes will take place late or won't happen at all.
PPACA calls for states to help set up health insurance distribution exchanges by Jan. 1, 2014. The exchanges are supposed to help individuals and small businesses use new tax subsidies to buy health plans that meet federal actuarial value and quality standards.
State exchange implementation plans are due at the U.S. Department of Health and Human Services (HHS) Jan. 1, 2013. If a state fails to set up an exchange program on time, Washington is supposed to step in and supply exchange services for the state's residents.
The Obama administration says states are making steady progress at implementation, but an analysis by The Associated Press shows that the status of implementation efforts varies widely from state to state.
WHO'S DONE WHAT
The AP's analysis divided states into four broad groups: Those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.
Thirteen states, plus the District of Columbia, have adopted an implementation plan.
In 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.
Four states — Arkansas, Florida, Louisiana and New Hampshire — have made no significant progress. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange for his state, but he is exploring a fallback option.
In the other 16 states, the outlook is unclear because of failures to advance legislation or because of paralyzing political disputes that often pit Republicans fervently opposed to "Obamacare" against other Republicans.
In Kansas, for example, Sandy Praeger, the insurance commissioner, is pushing hard for the development of a state exchange. But Gov. Sam Brownback returned a $31 million federal exchange implementation grant, saying the state would not act on implementing an exchange program before the Supreme Court rules on PPACA's constitutionality. Both officials are Republicans.
"It's just presidential politics," said Praeger, discussing the situation nationally. "It's less about whether exchanges make sense and more about trying to repeal the whole law."
Another 17 states have made substantial progress with developing an exchange system implementation plan but do not yet have a plan. Last week in one of those states, Wisconsin, Gov. Scott Walker, R, abruptly halted exchange planning efforts and announced he will return $38 million in federal money.
AP made up a list of states in which governors or legislatures have made significant commitments to setting up exchanges, and in which the states have accepted federal exchange establishment grants. The states on the list include many with Democratic governors, such as New York.
The list of states that have made substantial progress also includes some — such as Arizona, Indiana, New Jersey, New Mexico and Virginia — that have Republican governors.
STATES AND FEDS
The Obama administration said the differences in state exchange implementation efforts should not affect consumers.
"The fact of states moving at different rates does not create disparities for a particular state's uninsured population," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight (CCIIO) at the U.S. Department of Health and Human Services (HHS).
Larsen says the federal government will be ready to provide exchange services for the residents of the states that are unable or unwilling to do so.
But whatever agency takes charge has a big job ahead of it.
