Final State Decisions on Insurance Exchanges


The final tally is in of State decisions on the establishment of online health insurance marketplaces, or exchanges, with eighteen States agreeing to run a State-based exchange, eight planning on partnering  with the Federal government, and twenty-five deferring to a Federally run exchange.   The final decisions were made Friday, February 15, 2013, which was the deadline for States that had declined to establish exchanges themselves to decide whether they wanted to partner with the Federal government in running an exchange.   Of the thirty-three States that refused to establish the exchanges themselves, only eight took advantage of the partnership opportunity leaving the Federal government to run the exchanges in half of the States in the country, including Texas, Florida, and Pennsylvania.  State decisions split largely, though not entirely, along partisan lines.  The Kaiser Family Foundation has an interactive map showing the disposition of each State and other useful exchange-related information.  The exchanges, which are a cornerstone of the Affordable Care Act (ACA), are meant to provide a one stop destination for individuals and small employers to buy health insurance.  They are scheduled to open for business on October 1, 2013. 

With the final decisions in, the State tally is as follows.  States that have agreed to create their own exchanges:  California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont and Washington.  States that have requested a partnership with the Federal government:  Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and South Dakota, West Virginia.  States that have deferred to a Federally-run exchange:  Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Wisconsin and Wyoming. 

Reporter, Daniel J. Hettich, Washington, D.C., +1 202 626 9128,

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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