Bookmark and Share

February 2012 St@teside

Exchange Roundup

Steps Forward

In the 2012 legislative session, the Alaskan legislature plans to review a bill that was introduced in the last session. The bill would establish an exchange as a quasi-governmental entity and would require that the exchange apply for planning and establishment grants.

Arizona introduced a bill to establish a state-based health insurance exchange. The exchange board would have nine members: the director of the Department of Insurance, the director of the Arizona Health Care Cost Containment System Administration, four members appointed by the legislature, and three members appointed by the governor. The board is required to determine the minimum requirements for qualified health plan participation in the exchange and must submit an annual report on exchange activities to the legislature. The Department of Insurance would regulate the exchange.

The Arkansas Insurance Department published the state’s plan for a federal exchange partnership model.  Under this model the state has a choice of operating and receiving funding for insurance plan management and consumer assistance such as outreach and education and for establishing a navigator program, or it can allow the federal government to perform these functions. The state can use funds obtained through a cooperative agreement to perform various functions including assisting the Department of Health Services with planning Medicaid interfaces for the enrollment and eligibility portal.

Mayor Vincent Gray of the District of Columbia signed the Health Benefit Exchange Authority Establishment Act of 2011 on January 17, 2012, establishing an exchange as a quasi-governmental organization that would be “an independent authority of the district government.”  The exchange board will consist of 11 members. The seven voting members must be residents of the district and will be appointed by the mayor, but confirmation will be subject to approval by the district council. Four non-voting members, or their designees, will be ex-officio. In addition, the legislation calls for an Advisory Board consisting of nine members who are residents of the district and will make recommendations on a number of issues related to the implementation of an exchange including whether to use selective contracting, how to mitigate adverse selection, how to structure a navigator program, and the design and function of the Small Business Health Option Program (SHOP) beyond the requirements of the ACA.

On January 24, 2012, Florida’s legislature introduced a bill that includes exchange-related provisions such as building an internet-based system for eligibility determination for the Children’s Health Insurance Program (CHIP) that complies with the “applicable federal and state requirements.” The system would also facilitate enrollment in Medicaid, CHIP, and the federal exchange. The Health Care Appropriation Subcommittee has voted in favor of the bill.

A recent report recommended that Georgia set up a small business exchange outside of the Affordable Care Act-prescribed SHOP Exchange requirements. However, on January 25, 2012, Georgia’s legislature introduced a bill that would establish an exchange for the individual market—the Georgia Health Insurance Marketplace—as well as a SHOP exchange—the Small Business Health Insurance Marketplace.

On January 23, 2012, Iowa’s legislature introduced a bill that would establish an exchange that would separately operate the individual market and the small business market. The exchange would function as a nonprofit corporation.

Idaho’s legislature introduced a bill that would amend Title 41 of the state’s statute to set up a state-based exchange as an independent public body. The board would consist of nine members who would be appointed by the governor and would need to be confirmed by the state senate.

On January 30, 2012, New Jersey’s Senate introduced a bill that would establish an insurance exchange as a government agency. However, although it would be located administratively within the Department of Banking and Insurance, it would be independent of the department.

In Oregon, bills introduced in the House and Senate would continue to further the goal of setting up a state-based exchange. The Senate bill would repeal provisions of existing law requiring that the Oregon Health Authority receive legislative approval for proposals related to coordinated care organizations (CCOs). In addition it would repeal provisions requiring legislative approval of the Oregon Health Insurance Exchange Corporation’s business plan. In essence, the bill would allow work on CCOs and the exchange to move forward. The House bill would set up a funding mechanism—the Oregon Health Insurance Exchange Fund— which consists of money that the exchange receives from collecting premiums and fees as well as money received as grants.  Its purpose is to fund the operations of the exchange.

The Minnesota House dropped a bill on February 13, 2012, that would establish the “Minnesota Insurance Market Place.” The board would consist of 19 members, of whom four are appointed by the governor. Funds for the operations of the marketplace can come from government agencies, philanthropic organizations, and/or public and private sources. The marketplace would submit a progress reports to the legislature by March 15, 2013 and an annual report due each year on January 15.

Steps Back

On February 1, 2012, Illinois’s legislature introduced a bill that would prohibit the state from implementing any of the Affordable Care Act’s provisions until the Supreme Court decides on the constitutionality of the law.

In Missouri, the Senate passed a bill on February 2, 2012, that would not allow the state to establish a state-based exchange unless the exchange is created by a legislative act, an initiative petition, or referendum. The bill would also ensure that an exchange could not be established through an executive order. In addition, it would prohibit state agencies from any activities that would establish, create, administer or operate an exchange unless the agency has received statutory authority to do so.

In Virginia, bills previously introduced that would have established a state-based exchange have been voted down. The state’s decision on whether to set up an exchange hinges on the Supreme Court’s ruling on the constitutionality of the law. The state’s General Assembly may hold a special summer session to create an exchange if the Supreme Court upholds the law.1

On February 7, 2012, the Wisconsin legislature introduced a bill that requires state agencies interested in implementing any health reform-related provisions to obtain legislative authority.

1Reed, R. (2012, February 1). Bills to create health-care exchanges halted. Retrieved on February 13, 2012, from