As the nation awaits the Supreme Court decision on whether premium subsidies offered on the federal health insurance exchange are constitutional, state legislatures continue to pass or consider bills to prohibit or establish state-based exchanges.
A new report from the National Academy for State Health Policy, an association of policymakers at the state level walks through the activities and includes a large chart to easily find states of choice.
As of June 2015, 11 states introduced bills in their 2015 legislative session that call for the creation of state-based exchange or that designate the federal exchange as the states exchange, according to NASHP. In contrast, ten states introduced bills that either prohibit the establishment of a state-based exchange or propose to repeal an existing state-based exchange.
Other states, such as Montana and West Virginia, introduced bills that prohibit establishment of a state-based exchange without approval of the legislature. Additional states, including Pennsylvania, Delaware and Hawaii have indicated their intent to pursue the option of a state-based marketplace using the Healthcare.gov platform, and it is unclear at this time whether legislative action in these states would be needed to implement this option.
Some legislatures hostile to the ACA have considered or succeeded in sabotaging the law even before the Supreme Court decision. Arizona in April enacted a bill, H.B. 2643, prohibiting the state and all political subdivisions within it from using any personal or financial resources to enforce, administer or cooperate with the Affordable Care Act.
Among other provisions, the new Arizona law prohibits funding or implementing a state-based exchange, funding or aiding in the prosecution of any entity for violations of the ACA, and funding or administering any program or provision of the ACA.
The report from the National Academy for State Health Policy is available here.
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