By The Associated Press
NUMBER OF UNINSURED: 720,000 state residents are uninsured, or about 15.4 percent.
WHERE 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.
WHERE 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.
WHAT HAPPENS 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
WHERE 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.
WHAT 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.
WHERE 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.
WHERE 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.
WHAT HAPPENS 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 beneficiaries.
NUMBER OF UNINSURED: 656,000 state residents are uninsured, or about 13 percent.
WHERE 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.
WHAT 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.
WHERE 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.
WHERE 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.
WHERE 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.
WHERE 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.
WHAT 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.
WHERE 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.
WHAT HAPPENS 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.
WHERE 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.
WHAT 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 law.
NUMBER OF UNINSURED: 1,914,000 state residents are uninsured, or about 15 percent.
WHERE 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 health coverage.
NUMBER OF UNINSURED: 850,000 state residents are uninsured, or about 13.4 percent.
WHERE 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.
WHERE 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.
WHAT 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 required.
NUMBER OF UNINSURED: 350,000 state residents are uninsured, or almost 13 percent.
WHERE 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.
WHERE 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.
WHAT 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.
WHERE 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 in court.
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 overhaul.
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.
WHERE THE 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.
WHERE 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.
NUMBER 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.
WHERE 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.
WHERE 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.
WHERE 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.
WHERE 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.
WHERE THE STATE STANDS: Republican lawmakers in Montana who controlled the Legislature rejected any efforts to establish a health insurance exchange.
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 can proceed.
NUMBER OF UNINSURED: 237,000 Nebraska residents are uninsured, about 13 percent of the population.
WHERE 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.
WHERE 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.
WHERE 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 plans.
NUMBER OF UNINSURED: 1.3 million, or about 15 percent.
WHERE 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 the overhaul.
NUMBER OF UNINSURED: 433,000, or about 21 percent.
WHERE 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.
WHERE 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.
WHERE 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.
WHERE 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.
WHERE 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 government.
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.
WHERE 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.
WHAT 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.
WHERE 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.
WHAT 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 Act.
NUMBER OF UNINSURED: 1.37 million state residents are uninsured, or about 11 percent.
WHERE 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.
WHAT 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.
WHERE 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.
WHERE 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.
NUMBER 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.
WHERE 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.
WHERE 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.
WHERE 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.
WHERE 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.
WHERE 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 appeals court.
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
WHERE 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 exchange.
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 insurance pool.
NUMBER OF UNINSURED: 244,000 West Virginians are uninsured, or about 13.5 percent.
WHERE 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.
WHAT HAPPENS 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.
WHERE 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 decision.
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.
WHERE 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.