Oregon is moving forward with a health insurance exchange, approved by its legislature, and is also one of a handful of states to receive a special federal grant to develop innovative ways to build the technical infrastructure for an exchange, as a model for other states.

A seven-person board has been named to run the exchange. It will also create a consumer advisory committee and other advisory and technical committees it deems necessary. There will also be a four-member panel of legislators overseeing the process. Oregon has already held a series of public sessions to collect public comments on how the exchange should be designed.

Oregon’s exchange is set up as an active purchaser, which means it can set standards and negotiate with health plans that want to participate in the exchange, as opposed to simply listing all the ones offering qualifying plans.

The exchange will be paid for through fees on all the participating insurers. The exchange is supposed to have a formal business plan developed by Feb. 1, 2012.

Unlike many states, Oregon has thought through many of the design choices that need to be made, although it still has work to do. In a question-and-answer article in the Portland Oregonian, an exchange official described how consumers will use it. For instance, she noted that Oregonians should be able to begin enrolling in exchange insurance plans in October 2013. Also, eight insurance companies have expressed interest in participating.

More Oregon health insurance exchange links

Oregon Health Insurance Exchange
The website of Oregon’s Health Insurance Exchange, with information and updates that includes overview of the exchange, and links to meetings and resources.

Implementing Health Insurance Exchanges: Oregon
The Henry J. Kaiser Family Foundation overview of Oregon’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Oregon

Oregon Health Connect
Advocates on behalf of consumers who are insured with companies and agents that are licensed by the state of Oregon.
(855) 999-3210 / health.connect@state.or.us

This page last updated on February 8, 2012.

Updated on December 8, 2011.

The Wyoming Health Insurance Exchange Steering Committee is studying the feasibility of creating an insurance exchange. The panel’s work is being supplemented with research by the state Insurance Department.

The committee moved in late November to seek additional time to study the issue, and to leave the decision of whether to establish a state-run exchange for the legislature’s 2013 session.

The committee also voted to ask for another year to study such issues as the financial feasibility of an exchange in a state with a small population.

More Wyoming health insurance exchange links

Wyoming Insurance Department
Provides consumer protection and support to Wyoming residents by investigating consumer complaints and resolving issues on insurance matters.

(307) 777-7401 / Toll Free: 1-800-438-5768 / wyinsdep@state.wy.us

Implementing Health Insurance Exchanges: Wyoming
The Henry J. Kaiser Family Foundation overview of Wyoming’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Wyoming

Updated on December 8, 2011.

Virginia’s governor and legislature took the first steps toward creating a health insurance exchange by approving legislation to study the issue and bring back specific recommendations to the legislature. They should cover the structure of the exchange, the makeup of the governing board, resources required and other topics.

A Health Reform Initiative Advisory Council issued a recommendation in late November that an insurance exchange be established. It had previously agreed that the exchange should be a quasi-governmental agency whose members are appointed by the governor and which is financially self-supporting, according to a report in the Washington Times.

“It’s kind of like eating an elephant — one bite at a time,” Secretary of Health and Human Resources William A. Hazel Jr. told The Washington Times. “We all have to face this, and no one wants to.”

The exchange planning continues even as Virginia challenges the constitutionality of the federal health reform law’s individual mandate in court. In a letter accompanying the council’s report, Gov. Bob McDonnell reiterated his staunch opposition to the Affordable Care Act, but did not say whether he supports or opposes the state’s own insurance exchange.

More Virginia health insurance exchange links

Virginia Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 310-6560 / bureauofinsurance@scc.virginia.gov

Implementing Health Insurance Exchanges: Virginia
The Henry J. Kaiser Family Foundation overview of Virginia’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Virginia

Updated on December 8, 2011.

The head of Tennessee’s insurance exchange planning organization says the state will continue to work on building an exchange regardless of the legal challenges pending at the federal level.

State legislators in Tennessee have not yet considered an exchange bill, but state administrators are using $1 million in federal grant money to determine whether Tennessee should operate its own exchange.

The Department of Finance and Administration has hired subcontractors to analyze the possibilities. It has also been gathering input through in-person meetings, roundtables and technical assistance groups.

More Tennessee health insurance exchange links

Health Assist Tennessee
Helps connect Tennesseans with public and private programs to meet health care needs and assists TennCare members with access to medical care.
1-800-269-4038 (toll-free nationwide) / info@HealthAssistTN.org

Implementing Health Insurance Exchanges: Tennessee
The Henry J. Kaiser Family Foundation overview of Tennessee’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Tennessee

Updated on December 8, 2011.

South Carolina is studying whether to build a health insurance exchange based on an executive order from Gov. Nikki Haley; legislators were not able to approve a bill during the last session.

A top state health official recommended in mid-November that South Carolina not pursue its own health insurance exchange, but default to the federal version.

The governor’s order set up a 12-member Planning Committee that will recommend whether the state should establish an exchange.

Gov. Haley, a Republican, has said her administration will not seek any additional federal money for exchanges beyond the $1 million planning grant it already received, despite the availability of many millions. Tony Keck, head of the state’s Department of Health and Human Services, told the Spartanburg Herald-Journal that the federal government has not yet made clear its rules for the exchanges, so South Carolina would not know the true conditions for accepting the money.

The Democratic lawmaker who sponsored an exchange bill in the last session told the newspaper that uninsured people in South Carolina need help. “Governor Haley and all these people spouting the rhetoric have good health coverage,” said Gilda Cobb-Hunter. “The people who don’t have a place at the table, their voices are not being heard.”

More South Carolina health insurance exchange links

Implementing Health Insurance Exchanges: South Carolina
The Henry J. Kaiser Family Foundation overview of South Carolina’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: South Carolina

South Carolina Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(800) 768-3467  /consumers@doi.sc.gov

Updated on December 7, 2011.

Pennsylvania will establish a state-based insurance exchange, insurance department officials said in mid-November, despite the state’s involvement in a lawsuit challenging the federal health reform law.

Lawmakers considered but did not approve exchange legislation during their last session.

Pennsylvania Gov. Tom Corbett opposes federal health reform and the creation of exchanges.

However, the Insurance Department has been holding public hearings and working on a recommendation on whether Pennsylvania should build its own exchange or use one the federal government will provide on a national basis.

The state accepted a $3.4 million establishment grant and a $1 million planning grant from the federal government.

More Pennsylvania health insurance exchange links

Implementing Health Insurance Exchanges: Pennsylvania
The Henry J. Kaiser Family Foundation overview of Pennsylvania’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Pennsylvania

Health Care Section, Office of the Attorney General
Serves Pennsylvania consumers with health-related problems.
(717) 705-6938 / Toll-free: 1-877-888-4877 (only in Pennsylvania)

Pennsylvania Consumer Assistance Program
Assists people with private insurance, Medicaid, or other insurance with resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 881-6388 / ra-in-consumer@state.pa.us

Updated on December 7, 2011.

Oklahoma’s insurance exchange planning was handed to a joint legislative committee after lawmakers were unable to come up with a bill they could agree on.

The two Republican legislators leading the study group said they would be starting from scratch to learn what Oklahomans want to see from an insurance exchange. Both of the legislators are insurance agents. Their panel is holding a series of public meetings through the fall with plans to report back to the legislature during the next session.

The Joint Committee on Federal Health Care Law adjourned its final hearing in mid-November without any final decisions. However, an informal poll of panel members by the Tulsa World newspaper found that a majority favor a state exchange of some sort.

Oklahoma returned a large federal grant meant to help Oklahoma build the technical infrastructure for an exchange, under pressure from Tea Party Republicans who also kept related legislation from passing in Oklahoma. Gov. Mary Fallin refused the $54 million after first accepting it.

Meanwhile, six work groups have been meeting monthly focusing on various aspects of exchange development.

More Oklahoma health insurance exchange links

Implementing Health Insurance Exchanges: Oklahoma
The Henry J. Kaiser Family Foundation overview of Oklahoma’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Oklahoma

Oklahoma Insurance Department
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care. (405) 521-2991  / Toll Free in OK: (800) 522-0071 / ombudsman@oid.ok.gov

Updated on December 7, 2011.

Serious reservations about the concept of a health insurance exchange from the governor, lieutenant governor and some citizens are putting the Ohio exchange in jeopardy.

Lt. Gov. Mary Taylor, who also directs the state’s insurance department, complained that an exchange will be expensive and that Ohio’s top leadership would prefer to see the federal health reform law repealed, including the exchange requirement.

“It’s clear Ohioans want the freedom to choose the health care options that are best for them and their families,” said Jeff Longstreth, campaign manager for Ohioans for Healthcare Freedom, told the Cleveland Plain Dealer. “Ohioans want patients and doctors to make health care decisions, not government regulators.”

Brian Rothenberg, executive director of ProgressOhio, told the newspaper it is inexplicable why supporters of the proposed amendment want to abolish a law that promotes access to affordable health care.

In mid-July, Taylor was quoted by the Plain Dealer as saying the administration might refuse to create an exchange, though the newspaper reported on mixed signals from the state’s administration.

In response, Cathy Levine, executive director of the Universal Health Care Network of Ohio told the newspaper: “It’s astonishing that the administration would consider passing up an opportunity to create a more organized insurance marketplace that would help small businesses and individuals buy more affordable insurance.”

Levine agrees with Taylor that Ohio already has a robust insurance market, “but it doesn’t work for people with preexisting conditions. And that’s a lot of its population.”

More Ohio health insurance exchange links

Implementing Health Insurance Exchanges: Ohio
The Henry J. Kaiser Family Foundation overview of Ohio’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Ohio

Ohio Department of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Ohio.
(800) 686-1526 / life.health.mcd@insurance.ohio.gov

Updated on December 6, 2011.

Michigan is working toward the creation of a Michigan Health Marketplace. Though the legislature didn’t approve a law authorizing the exchange, Gov. Rick Snyder supports it and is encouraging legislators to get a bill in place by November 2011 so Michigan can apply for more federal grant funding.

The state Senate approved a bill Nov. 10, but a Crain’s Detroit Business report indicated it may not go much further for the rest of 2011.

At the same time, though, Michigan’s attorney general has joined other states that are challenging in court the constitutionality of parts of the federal health reform law.

Details on the governor’s vision for the Michigan Health Marketplace came out in September when Snyder gave a health-related speech that included the need for an exchange. He said it should be “a simple, clear system” to compare health plans, according to an account in Crains Detroit Business.

Snyder said he’d like the exchange to use technology that makes it easy for the consumer to use, comparing it with travel websites such as Travelocity and Orbitz.

More Michigan health insurance exchange links

Implementing Health Insurance Exchanges: Michigan
The Henry J. Kaiser Family Foundation overview of Michigan’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Michigan

Michigan Health Insurance Consumer Assistance Program (HICAP)
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 999-6442 / ofir-HICAP@michigan.gov

This page last updated on December 6, 2011.

Maine has made enough progress with its insurance exchange development that an exchange advisory committee and the governor are working through nitty-gritty issues such as whether the individual and small group markets should be separate, and what kind of governing authority the executive director should have.

The advisory committee’s role is to study the issues and recommend a course of action to the governor and legislature, which has not yet approved a law to create an exchange.

A report provided to the legislature by the advisory panel in September 2011 got mixed reviews from Democratic legislators, who worried that the exchange would not be consumer-friendly enough. But the advisory group’s chairman said the report recommends a consumer role in the exchange’s governing board.

Separately, he recommended a “go-slow” approach so Maine planners can take into account federal decisions on exchange policy as they become available.

In late November, Maine received $6 million in federal funds to build the exchange. Democrats in the legislature argued there’s a disconnect between the Gov. Paul LePage accepting the money while at the same time being among the states challenging the federal health reform law in court.

More Maine health insurance exchange links

Implementing Health Insurance Exchanges: Maine
The Henry J. Kaiser Family Foundation overview of Maine’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Maine

Consumer Health Care Division, Main Bureau of Insurance
Serves residents enrolled in private health insurance.
1-800-300-5000

Updated on December 6, 2011.

Kansas Gov. Sam Brownback is one of the most vociferous critics of health reform in the nation, and he has decided to give back $31.5 million in federal money that would have helped the state build its insurance exchange.

The exchange has been a matter of debate between Brownback and Kansas Insurance Commissioner Sandy Praeger, who has put together eight exchange planning work groups. The governor was initially supportive of her office’s work on exchange planning, but later saw the exchange as another piece of a flawed federal health plan that he opposes.

Praeger said in a Reuters news articlethat she was disappointed by the return of the grant, which was one of seven given to states that said they wanted money to come up with innovative ways to create the technical backbone of their exchanges.

The state legislature’s Joint Committee on Health Policy Oversight agreed with the insurance commissioner, recommending in mid-November that state agencies should pursue federal grants for an exchange.

But Praeger noted that a steering committee continues to do its work in Kansas, using a $1 million federal planning grant.

In a statement about his rejection of a grant that his state had earlier applied for, Brownback said, “Every state should be preparing for fewer federal resources, not more. To deal with that reality, Kansas needs to maintain maximum flexibility. That requires freeing Kansas from the strings attached to the Early Innovator Grant.”

Praeger, who is also a Republican, said the exchanges have become caught up in the debate over the constitutionality of the law’s individual mandate to purchase health coverage.

“There is a feeling among the more conservative elements around the country that if they pursue any efforts to establish exchanges, it will undermine their effort to get the law repealed,” Praeger said.

More Kansas health insurance exchange links

Implementing Health Insurance Exchanges: Kansas
The Henry J. Kaiser Family Foundation overview of Kansas’ progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Kansas

Kansas Insurance Department, Consumer Assistance Division
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Kansas.
(800) 432-2484 / Local: (785) 296-7829

Updated on December 6, 2011.

Nebraska’s Department of Insurance is working on creating an insurance exchange after the legislature failed to approve a bill to do so.

The Insurance Department is holding public hearings and is conducting analyses on the economic, financial and information technology issues related to a state-run exchange.

An analyst for the department said that its work so far indicates that a regional exchange is probably not going to happen, given the differences in various states’ insurance rules. He also said the state needs more details from the federal government about how the exchanges should be designed.

The state’s insurance director said in early December that the administration would prefer to have more direction from the federal government before taking additional steps toward an exchange. The legislature also appeared to be in a wait-and-see stance, with a top lawmaker stating that an exchange bill would probably not be approved during the regular 2012 session.

More Nebraska health insurance exchange links

Implementing Health Insurance Exchanges: Nebraska
The Henry J. Kaiser Family Foundation overview of Nebraska’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Nebraska

Nebraska Department of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Nebraska.
(877) 564-7323 / Toll Free: (800) 833-7352

Updated on December 5, 2011.

Iowa is inching its way toward an insurance exchange through the establishment of an insurance information exchange, which was approved in 2010. It provides consumers with comparisons of benefits, premiums and out-of-pocket costs of current health plans, but does not establish or sell any new plans as an exchange would do.

Legislation to establish a health exchange as envisioned by federal health reform failed in 2011, but the information exchange is seen as a helpful step toward establishing an actual insurance marketplace.

A committee has been holding hearings around the state and gathering opinions, and is expected to provide recommendations for moving forward in the fall.

Despite Gov. Terry Branstad’s opposition to the health reform law, he said in late November that Iowa would accept $7 million in federal grant money earmarked for insurance exchange development. State officials said much of the money would go toward upgrading the state’s Medicaid information systems. Medicaid systems will need to connect with a future insurance exchange so that exchange users who qualify for Medicaid can be signed up easily.

Meanwhile, the chairman of Wellmark, the state’s largest insurer, said in late August he wasn’t sure if the firm would participate in a state insurance exchange, saying it might not be in the company’s financial interests.

Andrew Cannon, a research associate for the Iowa Policy Project, countered in a Des Moines Register op-ed that it is premature for an important player such as Wellmark to take a stand well before an exchange is even designed in Iowa.

“Clearly, however, this puts the Wellmark cart in front of the health exchange horse,” Cannon wrote. “The task for Iowa lawmakers is to craft a marketplace that attracts consumers and maintains a level playing field for Wellmark and its competitors. The question is not whether Wellmark will participate, but whether Iowa will put together a health exchange that meets the two goals above, to benefit everyone — not just Wellmark.”

More Iowa health insurance exchange links

Implementing Health Insurance Exchanges: Iowa
The Henry J. Kaiser Family Foundation overview of Iowa’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Iowa

Consumer Advocate Bureau
Provides consumers with assistance in navigating the health care system, assistance programs, and other issues related to health insurance benefits.
1-877-955-1212 / consumer.advocate@iid.iowa.gov

Overview of PPACA Insurance Exchanges and State Exchange Options (PDF)
Iowa Legislative Health Care Coverage Commission

Updated December 5, 2011.

Idaho is moving ahead with planning a health insurance exchange, despite Republican Gov. Butch Otter’s discomfort with the health reform law as a whole.

Otter in September 2011 allowed an application for federal grant money to get the exchange going. But he told the Spokane Spokesman-Review that it would be better for the state to control the design of the exchange rather than handing that over to federal exchange officials.

“It’s a difficult choice, but one I find far preferable to suspobmitting to a federally established insurance exchange, with all the loss of control over our own destiny that entails,” Otter said. He said the exchange will be designed to make health coverage more accessible and affordable for Idahoans.

Republican lawmakers in Idaho remain uncomfortable with taking federal money to support any aspect of the reform law, and held back the state Department of Insurance’s proposed budget because it included some federal money to planning an exchange.

But state health and insurance officials asked the lawmakers to allow the grant money to be used, noting that 31 percent of Idahoans between ages 18 and 35 lack health insurance, and an exchange would help them.

In late November, state officials received word that they were being offered $20.4 million in federal funding in response to their request. It remained unclear whether the state legislature would accept the money when it next convened in 2012.

The exchange project was set to send specific recommendations to the governor and legislature in late 2011.

More Idaho health insurance exchange links

Implementing Health Insurance Exchanges: Idaho
The Henry J. Kaiser Family Foundation overview of Idaho’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Idaho

Idaho Department of Insurance
Answers questions about insurance bought on the individual market and insurance provided by an employer who only does business in Idaho.
(208) 334-4250 / toll-free (800) 721-3272

Arkansas will dismantle its planning process for a state-run health insurance exchange, the state’s insurance commissioner said in early December. He blamed opposition from Republicans in the state legislature.

Arkansas Gov. Mike Beebe, a Democrat, earlier chose not to seek a mutli-million-dollar federal grant to implement the exchange, citing opposition from Republican state lawmakers. This is despite the fact that both houses of the Arkansas legislature are controlled by Democrats and planning workgroups have been working on developing an exchange for the past year.

The governor said he would not seek the additional federal funding unless it was clear to him that the legislature wanted him to. He received a letter in opposition from several Republican lawmakers, and just one from a Democrat in support. Democrats contacted later said it should have been clear from their actions during the most recent legislation session that they supported the development of the exchange and still do.

The Arkansas State Chamber of Commerce said it was disappointed the state declined to apply for the grant. “We were disappointed that they made that decision, but we respect their decision” Randy Zook, the state chamber’s president and CEO, was quoted as saying in the Arkansas News. “We just think it would be better to have an exchange governed and managed by folks in Arkansas than be forced to deal with bureaucrats in Washington.”

Legislation to establish an exchange was considered during the 2011 legislative session but did not advance. The governor continues to support the Insurance Department’s planning effort but does not intend to issue an executive order to create the exchange, according to a Kaiser Family Foundation overview of state exchange progress.

Meanwhile, a planning effort involving more than 125 workgroup members continues. The steering committee is set to submit recommendations by Jan. 1, 2013. The next legislative session is not until 2013, which is after the date set in the federal reform law for states to confirm that they are setting up exchanges and don’t need the federal government to do it for them.

More Arkansas health insurance exchange links

Vision Statement for the Arkansas Health Benefit Exchange

Frequently Asked Questions

Arkansas Health Benefits Exchange Planning

Implementing Health Insurance Exchanges: Arkansas
The Henry J. Kaiser Family Foundation overview of Arkansas’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Arkansas

State of Alaska Division of Insurance

This page last updated on December 5, 2011.

Gov. Robert Bentley, a physician, opposes many of the provisions of the health reform law but believe the idea of giving individuals and small businesses easier access to purchasing health insurance is a good idea.

“I still believe even if that bill had never been passed that this was something that we needed to look at,” Bentley said in an article in the Sept. 16 Birmingham News.

Alabama’s Health Insurance Exchange Study Commission met for the first time on Sept. 16. Its mandate is to come up with a framework for the legislature to consider.

On November 29, the study commission presented its report, recommending that Alabama establish its own exchange, use a “free market facilitator” model and include both individuals and small businesses in the same exchange, though their risk pools would remain separate. The panel, which met four times, also recommended that the exchange be funded through assessments on all products sold in the small group and individual markets, both inside and outside the exchange.

Alabama’s legislature did not approve a health insurance exchange bill that was introduced in March 2011 before the session ended. But Gov. Bentley has said the legislation will be necessary in 2012 in order to get the exchange up and running.

Bentley was quoted in the Birmingham News as saying one possible outcome is allowing insurance companies to offer bare-bones health coverage through the exchanges.

About 14 percent of Alabama residents lack health insurance, according to the Kaiser Family Foundation.

A spokesman for Alabama Arise, a coalition of organizations that work on poverty and consumer issues, told the Montgomery Advertiser he was encouraged by the first meeting of the commission, though he thought it should have more consumer representatives.

The 14-member panel includes mostly health care and insurance company members, with one panelist representing consumers.

More Alabama health insurance exchange links

Implementing Health Insurance Exchanges: Alabama
The Henry J. Kaiser Family Foundation overview of Alabama’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Alabama

Executive Order establishing Alabama Health Insurance Exchange Study Commission

This page last updated on December 5, 2011.