Healthcare reform has been slowly implemented since 2010, and many states are in varying degrees of preparation for the dramatic expansion of coverage set to begin in January 2014. In order to comply with the Affordable Care Act (also known as “Obamacare’), governors and state legislatures have had to thoughtfully make decisions on issues concerning insurance regulations, Medicaid, the healthcare workforce, Health IT and other factors that will extend coverage to an estimated 32 million currently uninsured citizens.
The ACA requires each state to decide on the following:
Does the state create its own health insurance exchange?
This is the centerpiece for expanding coverage to individuals and families who do not receive benefits on the job, as well as for small businesses who currently receive expensive insurance rates on their own. These online marketplaces will offer easily-understood plans with a consistent minimum standard of benefits. Exchanges must be open for enrollment on Oct. 1, 2013, selling qualified insurance plans that will begin Jan. 1, 2014. Once open, members of Congress and their staffs will be required by law to purchase their own insurance on the exchange. Although the federal government has provided full funding for states to set up exchanges, dealing with the governance, logistics, and infrastructure is a large endeavor, and only 17 states have committed to operating their own.
Will the state expand Medicaid?
Although many states cover most persons who are under the poverty level ($22,050 for a family of four) in their Medicaid programs, other states exclude childless adults and parents entirely, or only allow them to participate with incomes far below the poverty line. The ACA intended to expand Medicaid coverage to everyone in the country at 133-138 percent of the poverty level or below. The federal government would initially pay for 100 percent of the budget for those newly eligible, ultimately tapering that off to 90 percent—a bargain compared to the percentage that states normally pay for Medicaid beneficiaries. However, the Supreme Court decision that upheld the ACA declared that states had the ability to reject the expansion, and some states are considering doing so.
Want to know how your state stacks up and what more work needs to be done by your statewide elected officials? Check out the chart below: