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5 States Among Early Innovators of Exchanges

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While federal court rulings against President Obama’s health care overhaul have gotten a lot of attention recently, not every state government is against the law. In fact, some are even moving ahead with efforts to support its implementation. The U.S. Department of Health and Human Services awarded seven cooperative agreements aimed at assisting a group of states designated as “Early Innovators” in creating the infrastructure to operate health insurance exchanges.

The states, which will divide up the $241 million are Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin and a multi-state entity led by the University of Massachusetts Medical School that consists of Connecticut, Maine, Massachusetts, Rhode Island, and Vermont.

Below, a closer look at five states that have been supportive of the overhaul.


California has been among the most active states in implementing reform. Assembly Bill 1602 and Senate Bill 900, both signed into law on Sept. 30, 2010, made California the first state to create independent health insurance exchanges for individuals and small businesses. The California Health Benefit Exchange, as the program is known, is to be overseen by a five-person panel. All in all, the California legislature has enacted six bills relating to health care reform into law, the highest number of any state.


Massachusetts was ahead of the game in 2006, then-Governor Mitt Romney signed into law a bill creating a health insurance exchange for the state. According to Massachusetts Health Connector, the independent state agency charged with operating the exchange, the law has enabled 98% of Massachusetts residents to obtain health insurance coverage. But Massachusetts did not stop at the creation of their exchange. SB 2585, signed by Governor Deval Patrick in August 2010, created a small group wellness incentive program that would allow such groups to receive federal health care tax credits.


While Maryland has yet to create a statewide health insurance exchange that does not mean that legislators in the Old Line State have failed to take any action. SB 57, signed by Governor Martin O’Malley in April 2010, implemented a number of parts of the federal health care reform law, including a provision barring insurance companies from denying coverage to children with pre-existing conditions as well as ensuring that people under the age of 26 may remain of their parents’ plan if they elect to. O’Malley created, via executive order, the Maryland Health Care Reform Coordinating Council and is on record as stating this his goal is to provide an additional 350,000 Maryland residents with health insurance through reform efforts.

Rhode Island

The commission created by Rhode Island to study health care reform implantation was given a broad range of responsibilities. SB 3021, adopted in June 2010, created a 17-member Senate commission charged with studying cost containment, efficiency and transparency hospitals treatment of patients, and rate reimbursements. The commission, which is also responsible for studying the creation of the state’s insurance exchange, has been stipulated to have regular meetings and is set to deliver a report on its findings to the Clerk on the Senate by May 31, 2011.

New Mexico

Early last year, Gov. Bill Richardson issued Executive Order 2010-012 that simultaneously created the New Mexico Health Care Reform leadership team and required the drafting of a plan for implementing health reform. The plan covers details ranging from the broad (the expansion of publicly funded benefits) to the very specific (Native American health). The state’s Human Services Department has been designated as the primary agency responsible for supporting the leadership team’s implementation blueprint.

In all, according to Saenz, 31 states have created some sort of implementation entity, meaning that even a few states that are party to one of the suits filed against the law have nonetheless begun compliance efforts

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