2015 State Legislative Activity: Health Insurance Exchanges

State legislatures have considered bills regarding health insurance exchanges each year since the Affordable Care Act (ACA) was enacted. But the upcoming U.S. Supreme Court decision in the case of King v. Burwell, which challenges whether the ACA’s premium subsidies can be made available in states with exchanges run by the federal government, could have significant implications for states that have chosen not to operate a state-based exchange.
This chart describes bills that have been introduced in states’ legislatures in 2015 that either call for or prohibit the establishment of a state-based exchange, as well as other related bills. As of June 2015, 11 states introduced bills in their 2015 legislative session that call for the creation of a state-based exchange or that designate the federal exchange as the state’s exchange. 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. Additionally, a few states introduced other bills related to exchanges, such as Montana and West Virginia, which introduced bills requiring that the establishment of a state-based exchange can only be authorized by the state legislature. As of June 16, 31 states had ended or were scheduled to end their 2015 legislative sessions. There may be extensions in some states; in other states some legislatures, such as Maine, return a few weeks after adjournment to act on any gubernatorial vetoes. For those who do adjourn before the U.S. Supreme Court rules, a special session would need to be called for legislative action to occur in these states.
In March 2015 NASHP published a policy brief outlining options for states if the U.S. Supreme Court rules in favor of King. In June 2015 NASHP issued a brief describing New Mexico’s exchange, which is a state-based marketplace using the healthcare.gov platform and services, and how this model could be an option for states with federally-facilitated and state partnership marketplaces to preserve marketplace subsidies if there is a pro-King ruling. Some other states, such as Pennsylvania, Delaware and Hawaii, have also 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.
State Refor(u)m will be tracking state activity related to the topic and will update the chart as information becomes available. Know of a bill that we should add to this compilation? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment below, or email acardwell@oldsite.nashp.org.