With the US Supreme Court expected to rule Thursday on the President Barack Obama's federal health care overhaul, here is a look at where each of the 50 states stands.
NUMBER OF UNINSURED: 720,000 state residents are uninsured, or about 15.4 percent.
THE STATE STANDS: Republican Gov. Robert Bentley, a physician, created a
commission in 2011 to recommend a plan for a health insurance exchange,
but he successfully opposed efforts by some legislators to enact one in
May. Critics said the bill would have limited the exchange to companies
operating statewide, which is one at this point. Bentley said it was
premature to act before the Supreme Court ruled.
WHAT HAPPENS NOW: Bentley said he will have to study the ruling before deciding what to do about an exchange.
NUMBER OF UNINSURED: 125,000 state residents are uninsured, or about 18 percent.
THE STATE STANDS: Alaska, which is among the states that sued over the
constitutionality of the federal health care law, has yet to implement a
health care exchange. The health department has hired a consultant to
help design one, and that report is expected soon.
NOW: Republican Gov. Sean Parnell is expected to take the report and the
U.S. Supreme Court decision into consideration in deciding how to
proceed on the health care exchange issue. Spokeswoman Sharon Leighow
declined to comment about contingency plans before the court's ruling.
NUMBER OF UNINSURED: 1.28 million state residents not covered, or about 19 percent
THE STATE STANDS: Arizona is among the states challenging the
constitutionality of the health care overhaul. The lawsuit covers about
22,000 people statewide, including some 14,000 people in the Phoenix
area. Republican Gov. Jan Brewer's administration is moving to implement
part of the contested law by reviewing health insurance rates to see if
they should be labeled unjustifiably high. The state also has accepted a
federal grant to create a state health insurance exchange.
HAPPENS NOW: If the Affordable Care Act is upheld in total or in part,
Arizona will make a final determination to move forward or defer to the
federal government on the health insurance exchange, the rate review
process and the other components of the law that can be implemented by
states. If the law is overturned, Arizona officials plan to work to come
up with their own health care changes with the goal of increasing
choice and competition.
NUMBER OF UNINSURED: 539,000 state residents are uninsured, or about 19 percent.
THE STATE STANDS: Arkansas decided on a federal-state partnership for
its health insurance marketplace. Legislators blocked a bill by which
the state would have created its own insurance exchange but have since
accepted a grant that will allow it to at least have a role in the
federally created exchange.
WHAT HAPPENS NOW: Insurance
Commissioner Jay Bradford says the state is well-positioned to implement
the law if it is upheld. If it is overturned, the state doesn't have a
plan for helping uninsured residents. Bradford said it would be up to
Congress to come up with a new solution.
NUMBER OF UNINSURED: NUMBER OF UNINSURED: 7,209,000 state residents are uninsured, or about 19 percent.
THE STATE STANDS: California has worked to be a model for the health
care law and has begun implementing parts of it already, including
creating the beginnings of health care exchanges to provide consumers a
marketplace to purchase insurance policies starting in 2014. The state
has also already banned insurers from refusing coverage for children
with pre-existing illnesses and young adults are allowed to stay on
their parents' plans through age 26 in California.
NOW: California has passed its own state legislation to ensure parts of
the federal law still will be implemented even if it is thrown out or
altered by the Supreme Court. If the law is upheld in its entirety,
California stands to gain as much as $15 billion annually in new federal
money for health programs one of the measure's biggest financial
NUMBER OF UNINSURED: 656,000 state residents are uninsured, or about 13 percent.
THE STATE STANDS: Colorado lawmakers passed legislation in 2011 to set
up health insurance exchanges, and a commission is in the process of
implementing them. The exchanges are set to start October 2013.
HAPPENS NOW: Lawmakers from both parties and the commission
implementing the exchanges have said they would like to proceed even if
the law is struck down. However, officials may have to discuss next
steps if a ruling compromises federal funding for the exchanges.
NUMBER OF UNINSURED: About 377,000 state residents are uninsured, or about 11 percent.
THE STATE STANDS: Connecticut has hired staff and a board of directors
to begin implementing health care exchanges and have them in place by
the 2014 deadline set by the federal law. The state already is allowing
people under 26 years old to stay on their parents' health insurance
policies, which is part of the federal law.
WHAT HAPPENS NOW:
Connecticut has already taken steps to implement the law in case it is
upheld. If it is overturned, Democratic Gov. Dannel P. Malloy said it
could cost the state $100 million and affect about 500,000 residents.
Malloy said his administration has been looking at the state's options
in case the ruling is overturned.
NUMBER OF UNINSURED: Between 100,000 and 110,000 Delaware residents are uninsured, about 11 percent of the state's population.
THE STATE STANDS: Delaware officials are working on a health care
exchange. State officials also are accepting public input as they come
up with minimum coverage requirements that must be included in health
care plans for individuals and small businesses.
WHAT HAPPENS NOW:
In his State of the State speech in January, Democratic Gov. Jack
Markell said current incentives reward neither efficiency nor quality,
resulting not in a health care system, but "a sick care system."
Markell spokesman Brian Selandar said that regardless of the ruling,
"our nation's health care system and marketplace are changing and must
continue to change to address the unsustainable increases health care
costs nationally, which the Affordable Care Act means to tackle."
NUMBER OF UNINSURED: 3.85 million Floridians are uninsured, or about 21 percent.
THE STATE STANDS: Republican Gov. Rick Scott ordered the state not to
accept federal money for implementing the health care law after he took
office last year. Florida has rejected or declined to pursue more than
$106 million and has returned $4.5 million. The state has its own health
insurance exchanges, mainly for small businesses but without an
individual mandate. The state has not implemented an exchange that would
meet the requirements of the federal law.
WHAT HAPPENS NOW: Scott
says if the federal law is upheld, Florida will continue to resist
implementation because he's hoping Mitt Romney will be elected president
and the law will be repealed. If that doesn't happen, Scott says
Florida will comply.
NUMBER OF UNINSURED: 111,000 state residents are uninsured, or 19 percent.
THE STATE STANDS: Georgia has done nothing to implement a health care
exchange. Lawmakers have introduced bills that would either allow or
hinder implementation of the law, though none have passed.
HAPPENS NOW: Gov. Nathan Deal, a Republican, opposes the health care
overhaul and voted against it while a congressman. But Deal has said he
would prefer that Georgia authorities, not the federal government,
implement the exchanges if the law is upheld. However, it's unclear if
Georgia would be able to meet federal deadlines to do that.
NUMBER OF UNINSURED: 97,000 state residents are uninsured, or 7.7 percent.
THE STATE STANDS: Hawaii has been moving at full speed in anticipation
the overhaul will be upheld. It joined several states last year in
filing a friend-of-the-court brief in support of the law. Gov. Neil
Abercrombie, a Democrat, said at the time the law preserved the best
elements of Hawaii's long-standing health care statutes. The state also
used a $300,000 private grant to create a state job for a coordinator to
implement the overhaul. Hawaii plans to develop its own insurance
exchange, a key component of the federal overhaul.
NOW: If the law is struck down, Hawaii still will try to develop its
insurance exchange and find ways to expand coverage for those who need
it, according to state Healthcare Transformation Coordinator Beth
Giesting. Giesting acknowledges the efforts will become more difficult
without federal funding. She says officials have considered various
scenarios — such as if the Supreme Court strikes down only the
individual health insurance mandate or Medicare expansion provisions —
and are prepared to conduct a full analysis to determine specific steps
once the ruling is issued.
NUMBER OF UNINSURED: 294,000 state residents are uninsured, or about 19 percent.
THE STATE STANDS: Idaho has not implemented health insurance exchanges,
over objections from insurers including Blue Cross of Idaho. The
GOP-controlled Idaho Legislature declined to accept federal grants for
the project and also balked at putting together a scaled-down
state-funded version while awaiting the Supreme Court's decision.
HAPPENS NOW: Idaho lawmakers were the first in the nation to pass a law
in 2010 requiring the state to sue the federal government over the
health care overhaul. In 2011, they toyed with the idea of nullifying
the law within state borders. Now, they're banking on the U.S. Supreme
Court turning down the measure, or barring that, an eventual push by a
Republican president and GOP members of Congress to repeal provisions,
including the individual mandate or refuse to fund the enterprise. Many
GOP lawmakers in Idaho have said they would work hard to block key
provisions of the health care changes if the Supreme Court upholds the
NUMBER OF UNINSURED: 1,914,000 state residents are uninsured, or about 15 percent.
THE STATE STANDS: Illinois has received three federal grants to study
and start building its health insurance exchange, but the Legislature
has failed to pass a law establishing it. Gov. Pat Quinn, a Democrat,
has considered an executive order to do that, but now may pursue a
federal-state partnership instead.
WHAT HAPPENS NOW: The Quinn
administration was waiting for the Supreme Court ruling before making
public comments about what will happen next in President Barack Obama's
home state. Quinn has been an enthusiastic supporter of the overhaul,
but other state lawmakers, including Democrats, have backed away from
the law as its critics grew louder. If the court overturns all or most
of the law, Illinois lawmakers say they may come up with their own
suggestions for addressing rising insurance costs and people losing
NUMBER OF UNINSURED: 850,000 state residents are uninsured, or about 13.4 percent.
THE STATE STANDS: Republican Gov. Mitch Daniels ordered state agencies
to build a framework for a possible exchange, but he has not implemented
one pending the Supreme Court ruling. Indiana also has pushed to use
its health savings account to help cover an estimated 500,000 who will
become eligible for Medicaid in 2014 under the federal health care
overhaul, but federal officials denied the request in September, saying
it was premature.
WHAT HAPPENS NOW: Although Indiana has planned
for its own insurance exchange, it still could be forced into the
federal one if the court upholds the law. Indiana hasn't enacted a law
creating its own exchange and Daniels told the agencies to keep their
work in the planning stages. State officials haven't said what they
might do to address health coverage if the law is struck down.
NUMBER OF UNINSURED: 366,000 Iowa residents are uninsured, about 12 percent of the population.
THE STATE STANDS: The state does not have a law establishing a health
insurance exchange, and Republican Gov. Terry Branstad has said Iowa
will create a state-based exchange only if the law is upheld. The
Republican House Majority leader says the state has already enacted
several pieces of the law, including a website that helps residents find
insurance, but the state has yet to comply with other requirements.
HAPPENS NOW: The Iowa Department and Health and Human Services the
state Insurance Division have been planning for an insurance exchange in
case the law is upheld. Democrats who control the Senate say they will
push for such an exchange even if the law is rejected, but the plan
would likely face opposition from Branstad and the Republican-controlled
Iowa House. House Majority Leader Linda Upmeyer says the state agencies
will continue to prepare Iowa until lawmakers reconvene in January. But
some Senate Democrats say a special legislative session may be
NUMBER OF UNINSURED: 350,000 state residents are uninsured, or almost 13 percent.
THE STATE STANDS: The Republican-dominated state government has been
hostile to the 2010 federal law and hasn't moved to set up a health care
exchange. Last year, GOP Gov. Sam Brownback's administration returned a
$31.5 million federal grant.
WHAT HAPPENS NOW: If the entire law
is upheld, Kansas won't be in a position to set up an exchange in time,
according to the state Insurance Department. If that part of the law
survives, Brownback's administration would have to decide whether to try
to partner with the federal government on running the exchange. If the
entire law is struck down, Brownback and other state officials are
likely to take no further action.
NUMBER OF UNINSURED: 640,000 state residents are uninsured, or about 15 percent.
THE STATE STANDS: Kentucky has laid the groundwork for a statewide
health insurance exchange, but Democratic Gov. Steve Beshear opted to
wait for the Supreme Court ruling before moving doing anything more.
HAPPENS NOW: Beshear says if the law is upheld, he will sign an
executive order creating the state's health insurance exchange.
NUMBER OF UNINSURED: 886,000 state residents are uninsured, or about 20 percent.
THE STATE STANDS: Louisiana has not implemented health care exchanges,
instead choosing to have the federal government create and operate them.
Republican Gov. Bobby Jindal and Attorney General Buddy Caldwell oppose
the health care law, and Louisiana is one of the states challenging it
WHAT HAPPENS NOW: If the law is upheld, Jindal looks
next to the fall election cycle, hoping Republicans will win the
presidency and take control of Congress and repeal the health care
NUMBER OF UNINSURED: 121,000 state
residents uninsured, or about 9.4 percent. The number may rise due to
Medicaid cutbacks authorized by the latest state budget.
STATE STANDS: Maine had a task force to create a health care exchange,
but legislation implementing one was set aside until after the Supreme
Court's decision. Maine has passed laws implementing components of the
law, such allowing parents to add coverage of children up to age 26 and
outlawing denial of insurance coverage due to pre-existing conditions.
Maine has also passed a law that will allow consumers to shop
out-of-state for coverage.
WHAT HAPPENS NOW: If the law is upheld,
protections for consumers will remain. The insurance exchange will at
least be initially designed by the federal and not state government. If
the law is struck down, Maine residents could lose protections from
sharply increased insurance rates.
NUMBER OF UNINSURED: 747,000 state residents are uninsured, or about 13 percent.
THE STATE STANDS: Maryland has passed legislation to create a health
care exchange, setting up standards and regulations to run the program
and creating the framework for a marketplace where individuals and small
businesses can purchase coverage.
WHAT HAPPENS NOW: Marc
Goldberg, a spokesman for Democratic Lt. Gov. Anthony Brown, said that
if the law is struck down, Brown and the governor "are committed to
utilizing the work that's already been done on this front to the best of
the state's ability, working in concert with all stakeholders." Health
Secretary Joshua Sharfstein says Maryland, which has worked to tailor
its approach to the state's needs, is on track to meet deadlines if the
law is upheld in its entirety.
OF UNINSURED: Massachusetts says 120,000 people, or about 2 percent of
the population, remained uninsured in 2010. The U.S. Census Bureau had a
somewhat higher estimate of about 370,000 people, or more than 5
percent of the population.
WHERE THE STATE STANDS: Massachusetts
passed a sweeping health care law in 2006 that became the blueprint for
the federal overhaul. Many of the key elements of the federal law,
including the "individual mandate" requiring nearly everyone have
insurance, remain the law in Massachusetts.
WHAT HAPPENS NOW:
Massachusetts officials say that no matter how the Supreme Court rules,
the state will forge ahead with its efforts to expand coverage to nearly
all residents, although the state could lose hundreds of millions in
assistance if the federal law is knocked down.
NUMBER OF UNINSURED: 1.27 million Michigan residents are uninsured, about 13 percent of the population.
THE STATE STANDS: The Department of Licensing and Regulatory Affairs
has been working to set up a health insurance exchange but has had
limited success because House Republicans refuse to let it use $9.8
million in federal planning dollars. Because of looming federal
deadlines to have an exchange in place, state officials are planning for
a state-run exchange while also talking to federal officials about a
possible partnership on a federal exchange where the state handles just
some responsibilities, such as customer service.
WHAT HAPPENS NOW:
If the health insurance exchange is upheld by the U.S. Supreme Court,
state officials hope the House will approve spending the $9.8 million
when it returns to session July 19. In the meantime, the state will try
to apply for more federal funds so it can get the exchange up and
running, whether on its own or with the federal government. If the
exchange is struck down, Republican Gov. Rick Snyder, who has previously
expressed support for the idea, says he's more likely to focus on
wellness initiatives than pursuing a state exchange.
NUMBER OF UNINSURED: 509,000 state residents are uninsured, or about 9.8 percent.
THE STATE STANDS: Minnesota has embraced the health care overhaul more
than many states. Democratic Gov. Mark Dayton used a provision in the
federal law to extend Medicaid coverage to more than 80,000 vulnerable
adults as soon as he took office in 2011. His administration has focused
on developing an online health insurance exchange envisioned as a key
part of the law, securing $28.4 million from the federal government for
Minnesota's planning efforts.
WHAT HAPPENS NOW: Top administration
officials aren't saying how they would maintain coverage of those
vulnerable adults if the federal support goes away. Any new state
spending would need the help of Republicans, which appears unlikely. One
top GOP lawmaker on health care issues says an overturned law would
allow the state to pursue a more market-oriented approach.
NUMBER OF UNINSURED: 618,000 state residents are uninsured, or about 21 percent.
THE STATE STANDS: Mississippi Insurance Commissioner Mike Chaney, a
Republican, has been working on a health care exchange and has accepted
federal money for the project. The exchange originally was proposed by
Republican Haley Barbour when he was governor.
WHAT HAPPENS NOW:
Chaney says Mississippi will continue to work on its health care
exchange, regardless of how the Supreme Court rules.
NUMBER OF UNINSURED: 835,000 state residents are uninsured, or about 14 percent.
THE STATE STANDS: Missouri received an initial planning grant but has
not implemented a health insurance exchange because of opposition to it
by some Republican state senators.
WHAT HAPPENS NOW: Regardless of
the Supreme Court ruling, Missouri residents will vote in November on a
ballot measure asking whether Democratic Gov. Jay Nixon's
administration should be barred from implementing an insurance exchange
without specific authority in state law. Nixon has said he will not
order the creation of an insurance exchange.
NUMBER OF UNINSURED: 176,000 state residents are uninsured, or about 18.1 percent.
THE STATE STANDS: Republican lawmakers in Montana who controlled the
Legislature rejected any efforts to establish a health insurance
WHAT HAPPENS NOW: If they law is upheld, Montana will
likely use the health exchange established by the federal government for
states that choose not to do it themselves. State authorities say they
will have to see what the court does exactly before determining how they
NUMBER OF UNINSURED: 237,000 Nebraska residents are uninsured, about 13 percent of the population.
THE STATE STANDS: The state does not have a law establishing a health
insurance exchange. However, Republican Gov. Dave Heineman has
instructed the state Department of Insurance to plan for one in case the
law is upheld.
WHAT HAPPENS NOW: Department of Insurance
officials say they are planning for an exchange in case the law is
upheld. To move forward with one, Heineman could issue an executive
order, though his office has declined to comment until after the ruling.
Democrats in the Legislature say they will push for an open process
that includes lawmakers and the public. Nebraska lawmakers say little
will happen in the state if the court rejects all or most of the law.
NUMBER OF UNINSURED: 563,000, or about 21 percent.
THE STATE STANDS NOW: The Nevada Legislature in 2011 passed a bill
implementing the Silver State Health Insurance Exchange and creating a
seven-member board to oversee it. Republican Gov. Brian Sandoval opposed
the federal health care law as a candidate. He also allowed a private
attorney appointed by former Gov. Jim Gibbons to continue representing
Nevada in the lawsuit filed by more than two dozen states challenging
the law. State officials estimate the Affordable Care Act would cost
Nevada $575 million in the first five years as more people become
eligible for Medicaid.
WHAT HAPPENS NOW: Sandoval's administration
has planned to implement the law unless it is overturned. The
governor's office has said administration officials would review the
U.S. Supreme Court ruling before commenting on the state's next steps.
NUMBER OF UNINSURED: 134,000 state residents are uninsured, or just more than 10 percent.
THE STATE STANDS: New Hampshire currently has laws that echo portions
of the Affordable Care Act, such as allowing dependent unmarried
residents to remain on their parent's health care insurance until age
26. Last year, state legislators passed laws that said residents cannot
be required to obtain health insurance or be fined for not being
covered. They also established a state oversight committee that must
give its OK before the federal law is implemented. Democratic Gov. John
Lynch's office said it has done some work on implementing aspects of the
Affordable Care Act, but has put plans on hold until the U.S. Supreme
Court makes its ruling.
WHAT HAPPENS NOW: Lynch's office said they
were waiting to hear the Supreme Court's decision before deciding how
to move forward. Spokesman Colin Manning would not elaborate on specific
NUMBER OF UNINSURED: 1.3 million, or about 15 percent.
THE STATE STANDS: The Legislature passed a law to set up a state health
insurance exchange, but Republican Gov. Chris Christie vetoed the
measure in May, saying he did not want to spend money on something that
could be ruled unconstitutional.
WHAT HAPPENS NOW: Christie said
in May that he intends "to fully oversee New Jersey's compliance in a
responsible and cost-effective way" if the U.S. Supreme Court upholds
NUMBER OF UNINSURED: 433,000, or about 21 percent.
THE STATE STANDS: New Mexico this week announced formation of a task
force to develop a proposal for creating a state health insurance
exchange. Republican Gov. Susana Martinez's administration is also
working on an overhaul of Medicaid to try to slow the growth of the
program without cutting enrollment or changing who's eligible to receive
medical services. The state wants to have the revamped Medicaid program
implemented in the fall of 2013.
WHAT HAPPENS NOW: A spokesman
for the state Human Services Department says New Mexico will establish a
state health insurance exchange regardless of how the U.S. Supreme
Court rules. State officials say it will be next year, at the earliest,
before an exchange could be implemented.
NUMBER OF UNINSURED: 2,886,000 state residents are uninsured, or about 15 percent.
THE STATE STANDS: Democratic Gov. Andrew Cuomo issued an executive
order April 12 to establish a statewide health insurance exchange, where
individuals and small businesses could tap up to $2.6 billion in
federal tax credits and subsidies, planning to show by January that the
state is ready to participate, start taking applications the following
October and start operating Jan. 1, 2014.
WHAT HAPPENS NOW: New
York will be in a good position if the federal law is upheld in its
entirety and appears on track to continue planning for a state insurance
exchange even if the law is struck down, but Cuomo spokesman Peter
Constantakes says health officials will analyze the impact of the
Supreme Court's ruling once it happens.
NUMBER OF UNINSURED: 1.57 million state residents are uninsured, or about 17 percent.
THE STATE STANDS: Legislation aimed at prohibiting the mandate for
individuals to buy health insurance was the first item introduced after
Republicans took over control of by North Carolina's General Assembly
last year. Lawmakers haven't been able to overcome Democratic Gov.
Beverly Perdue's veto of their bill. But work to design health care
exchanges has stalled since last summer.
WHAT HAPPENS NOW: House
Majority Leader Paul Stam said a Supreme Court ruling overturning or
partially rejecting the individual mandate may be enough to sway the
handful of Democratic votes needed and justify another effort to
override Perdue's veto. Stam and other Republican legislators aren't
saying whether they have contingency plans for the federal law being
partially or entirely upheld.
NUMBER OF UNINSURED: 83,000 North Dakota residents, or about 13 percent, had no health insurance in 2010.
THE STATE STANDS: Legislators rejected a state-run health insurance
exchange last year. Majority Republicans said it was too complex and too
expensive and to do so would be tantamount to accepting the federal
health care overhaul.
WHAT HAPPENS NOW: If the law is overturned, a
health care official says funding for the state's 15 community health
centers may be threatened and three others that are planned might not be
built. If the law is upheld, North Dakota officials say a special
session could be called to deal with an insurance exchange. Lawmakers
could delay any action until after the November elections, to see who
wins the presidency and the control of Congress, but doing so could
effectively turn the task over to the feds, given the Nov. 16 deadline
for submitting exchange plans to the federal government.
NUMBER OF UNINSURED: More than 1.5 million state residents are uninsured, or about 14 percent.
THE STATE STANDS: Ohio has not moved to create a health care exchange
but is evaluating its options. It received a $1 million federal exchange
planning grant in 2010. Republican Gov. John Kasich's administration
has taken advantage of some parts of the new law to expand coordinated
care and propose changes to Medicaid eligibility. Democrats have
unsuccessfully pushed bills in the Legislature to set up a state-run
exchange. But Lt. Gov. Mary Taylor, who is also Ohio's insurance
director, frequently criticizes the overhaul and says it's premature to
plan for an exchange without further clarification from the federal
WHAT HAPPENS NOW: Kasich has said he'd rather have the
state set up the exchange than "a bunch of people in Washington who
can't seem to get out of their way come in here and try to run Ohio."
State officials have not said whether Ohio is far enough along to have a
state exchange set up by 2014.
NUMBER OF UNINSURED: About 624,480 Oklahomans are uninsured, or about 17 percent of the state's population.
THE STATE STANDS NOW: Oklahoma lawmakers first rejected $54 million in
federal funding to create a health care exchange and then decided to
take no action on developing an exchange, deciding instead to wait and
see whether the law is upheld by the U.S. Supreme Court.
HAPPENS NOW: Oklahoma Gov. Mary Fallin said her first hope is that the
federal law is overturned, allowing states to pursue their own health
care solutions. Fallin intends to determine the state's course of action
after the Supreme Court decision is handed down.
NUMBER OF UNINSURED: 612,000 state residents are uninsured, or about 16 percent.
THE STATE STANDS: Oregon is working aggressively to implement the
health care law and is farther along than most other states. The federal
government has committed more than $60 million in grants to develop a
health insurance exchange that could be duplicated in other states.
HAPPENS NOW: State officials say they'll try to create an exchange no
matter what the Supreme Court rules, but the court's decision could
leave them short on cash or require them to redesign the business model.
Democratic Gov. John Kitzhaber says the Supreme Court's decision will
have no impact on Oregon's work to create "coordinated care
organizations" to lower Medicaid costs. The regional organizations would
be responsible for integrating mental, medical and dental care for
Medicaid patients and intensively managing chronic conditions like
diabetes to keep patients out of the hospital. The Obama administration
has tentatively agreed to give Oregon nearly $2 billion to help
implement it, and state officials say that money is not in jeopardy
because it comes from a program that predates the 2010 Affordable Care
NUMBER OF UNINSURED: 1.37 million state residents are uninsured, or about 11 percent.
THE STATE STANDS: Republican Gov. Tom Corbett, as state attorney
general in 2010, joined a group of state officials in challenging the
law. Still, Pennsylvania is working to set up a health insurance
exchange required by the law, although the state Insurance Department
says it is waiting for the Supreme Court's decision before it touches a
$33 million grant it won in January to build out the exchange.
HAPPENS NOW: The state will proceed with the development if the law is
upheld in its entirety. State Insurance Department officials will
otherwise be watching to see how the court decision affects the amount
of state money necessary to operate the exchange, whether consumers
would still use an exchange without government subsidies and whether the
federal government would still fund its initial development if all or
some of the law is struck down.
NUMBER OF UNINSURED: 119,000 state residents are uninsured or about 11.4 percent.
THE STATE STANDS: Rhode Island has received $58 million in federal
funds to assist in the creation of its health benefits exchange. Gov.
Lincoln Chafee, an independent, last week picked a former state health
official to direct the exchange.
WHAT HAPPENS NOW: Chafee says
even if the health care law is overturned, Rhode Island will move
forward with its exchange, which officials say they hope to have up and
running late next year.
NUMBER OF UNINSURED: 930,000 state residents are uninsured, or more than 20 percent.
THE STATE STANDS: South Carolina, which is among the states that sued
over the constitutionality of the federal health care law, opted not to
implement health care exchanges after a panel concluded there were too
many unanswered questions.
WHAT HAPPENS NOW: South Carolina is
working to implement certain health care changes, such as a project to
better coordinate Medicare and Medicaid. State health officials say they
will begin enrolling about 70,000 children who are currently eligible
but not yet enrolled in Medicaid as a way to ramp up for the large
Medicaid enrollment expansion scheduled to start in 2014. But Republican
Gov. Nikki Haley's office says South Carolina won't consider any change
in policy until after the November elections.
OF UNINSURED: Federal officials estimate 105,000 state residents are
uninsured, or about 13 percent; South Dakota officials say state survey
data is lower, about 9 percent.
WHERE THE STATE STANDS: Republican
Gov. Dennis Daugaard has delayed work on setting up a health insurance
exchange until the Supreme Court's decision.
WHAT HAPPENS NOW:
Daugaard says even if the law is upheld, South Dakota won't move forward
with implementing a health insurance exchange until after the November
election. He hopes Republicans will win the presidency and take control
of Congress and repeal the law. If the law is struck down entirely, it
would jeopardize grant money that helps pay for community health centers
around the state.
NUMBER OF UNINSURED: About 930,000 people, or 15 percent.
THE STATE STANDS: Tennessee has laid the groundwork for a health
insurance exchange but would have to wait until the Legislature returns
in January to complete it.
WHAT HAPPENS NOW: Republican Gov. Bill
Haslam says the state is prepared to implement the requirements of the
health care law, despite his concerns about the cost. The state has kept
more than $200 million of surplus revenues in reserve to help defray
those costs. If the law is overturned, it's unlikely the state would
move forward with an insurance exchange.
NUMBER OF UNINSURED: About 6.2 million, or about 25 percent.
THE STATE STANDS: Texas has not implemented a health care exchange.
Texas has joined with other states in challenging the law in court. Gov.
Rick Perry, who is vocally opposed to the law, says the state can
"deliver health care more efficiently, more effectively and cheaper than
the federal government can."
WHAT HAPPENS NOW: If the law is
upheld, the state may be forced into the federal government's health
insurance exchange because Texas has lagged in creating its own online
marketplace. However, a spokeswoman for Texas Health and Human Services,
which oversees Medicaid in the state, said the agency has already
implemented parts of the law. Perry and other Republican leaders have
offered few solutions on how to drive down health care costs if the
court overturns the law.
NUMBER OF UNINSURED: 386,000 state residents are uninsured, or nearly 14 percent.
THE STATE STANDS: Utah implemented a health insurance exchange before
the federal Affordable Care Act was passed to help small businesses
obtain insurance coverage for their employees. Utah is among 26 states
that sued the federal government over the law. Republican Gov. Gary
Herbert has criticized the individual mandate and the expansion of
Medicaid rolls that administration officials say would cost the state
hundreds of millions of dollars.
WHAT HAPPENS NOW: Herbert administration officials say Utah's exchange program will continue regardless of the ruling.
NUMBER OF UNINSURED: 59,000 state residents are uninsured, or about 9.5 percent.
THE STATE STANDS: Vermont in 2011 passed legislation to use the
insurance exchange called for under the federal health care law as a
springboard to launch a statewide, universal, publicly funded health
care system by 2017.
WHAT HAPPENS NOW: Democratic Gov. Peter
Shumlin says he's "bound and determined" to push ahead with the state's
plan, but worries about the up to $400 million a year in federal
subsidies that would be lost if the federal law is struck down. He vows
to push ahead with cost controls, like set budgets, rather than
fee-for-service payments, for doctors and hospitals. "Health care reform
in Vermont will not wither on the vine because of actions by the U.S.
Supreme Court," Shumlin says.
NUMBER OF UNINSURED: Nearly 1.1 million state residents are uninsured, or about 14 percent.
THE STATE STANDS: Virginia has expressed its intent to create a health
care exchange, but Republican Gov. Bob McDonnell has not acted on
recommendations made by a gubernatorial advisory council. Virginia filed
its own lawsuit challenging the health care law, but lost in federal
WHAT HAPPENS NOW: McDonnell is waiting to see what
the Supreme Court does before moving on creation of a health care
exchange, but he has declined to say whether he will wait until after
the November election.
NUMBER OF UNINSURED: 927,000 state residents are uninsured, or about 13.8 percent
THE STATE STANDS: Republican Attorney General Rob McKenna signed on to
the health care lawsuit against the wishes of the state's Democratic
governor and majority Democrats, but Washington state moved ahead this
past legislative session with implementing its own health insurance
WHAT HAPPENS NOW: If the act is overturned, the state's
exchange could still be put in place, but federal funding, including a
planned major expansion of Medicaid, would likely be lost. If only the
mandate is overturned, there would be no short-term or long-term impact
on Medicaid or its current caseload. Some Democratic lawmakers and
others have already planned a summit in late July to develop a
legislative response to whatever the court decides and plan for the next
legislative session that begins in January. Another question is what
will happen to federal funding the state has received if the law is
overturned. Washington received $128 million to help set up its
exchange, and an additional $200 million for its preexisting condition
NUMBER OF UNINSURED: 244,000 West Virginians are uninsured, or about 13.5 percent.
THE STATE STANDS: West Virginia has enacted legislation allowing for a
state-run health care exchange, but the state has slowed the pace of
setting it up to see how the Supreme Court rules.
NOW: State officials say they won't know how to proceed until the
ruling. West Virginia did, however, begin studying the health care
exchange concept before it became part of the federal overhaul.
NUMBER OF UNINSURED: 526,000 state residents are uninsured, or about 9 percent.
THE STATE STANDS: Wisconsin has not begun setting up its health
insurance exchange. Work on that was put on hold in January by
Republican Gov. Scott Walker, who wanted to await the Supreme Court's
WHAT HAPPENS NOW: Walker said that regardless of the
Supreme Court's ruling, Wisconsin will not move forward with
implementation until after the November elections. Walker hopes
opponents of the health care law will win the presidency and take
control of Congress and repeal it. If the law is struck down entirely,
Democrats want to pursue putting key parts of it in place in Wisconsin,
while Republicans and Walker have been less specific about what
initiatives they would pursue.
NUMBER OF UNINSURED: 93,000 state residents are uninsured, or about 17 percent.
THE STATE STANDS: Wyoming has not implemented health care exchanges,
but a steering committee is studying an exchange for Wyoming and will
present a report to the Legislature this fall.
WHAT HAPPENS NOW:
Republican Gov. Matt Mead says the will state evaluate it options after
the Supreme Court ruling. Mead has said he considers the federal health
care law bad policy.
Source: Associated Press