All 50 states met the Health and Human Services (HHS) December 14 deadline to declare whether they will set up their own health insurance exchange under the Affordable Care Act. Thirty-two states have declined to operate their own exchange.
States not running their own exchanges can opt for one of two alternatives: a federal partnership exchange in which states help by performing certain duties, or a federally facilitated exchange that requires minimal state participation. Eighteen states and the District of Columbia have stated that they will establish their own exchanges, seven states will enter into a partnership with the government to operate their exchanges and 25 states have deferred to the government to operate an exchange for them.
About 115 million people live in D.C. and the 18 states that will run their own exchanges, including 9.8 million who are uninsured and might meet the income threshold to qualify for subsidies to purchase coverage through the exchanges. Meanwhile, an estimated 197 million people live in the other 32 states, including about 18.3 million who are uninsured and could qualify for the tax.
States that will operate their own exchanges still need to complete numerous tasks before the deadline for open enrollment, which is scheduled to begin on October 1:
- Build websites to determine consumer eligibility for insurance subsidies and offer details on plans’ premiums;
- Create support programs for those purchasing insurance for the first time;
- Conduct logistical preparations, such as hiring exchange employees and setting up physical offices; and
- Choosing a name for the exchange.