State Exchange Update: Bills, Bills, Bills

As state legislative sessions wind down, activity around Exchanges is heating up. Three states (California, West Virginia, and Maryland) have enacted Exchange establishment legislation andVirginia has enacted legislation stating an intent to create an Exchange. Six other states still have active legislation that is moving forward. Washington, Hawaii, Colorado, Vermont, and North Dakota passed legislation that is now awaiting the governor’s signature. Oregon’s bill has passed one chamber of the legislature. Here is a summary of the legislation:

• Virginia’s HB 2434 passed the legislature and was signed into law by Governor McDonnell. The law states Virginia’s intent to establish and operate its own Exchange. It also requires the Secretary of Health and Human Resources to work with the Assembly, experts, and stakeholders to provide recommendations on various issues for the 2012 session.

• Washington’s SB 5445 was passed by the legislature on April 22 and is expected to be signed into law by Governor Gregoire who has supported it. The bill establishes the Exchange as a separate nonprofit, and calls for the creation of a governing board. The bill also charges the Washington Health Care Authority, legislature, and board with undertaking an analysis on a wide variety of options for the Exchange.

• Hawaii’s SB 1348 passed on May 6 and is expected to be signed by Governor Abercrombie, who has expressed support for the bill. The bill establishes the Exchange as a nonprofit and creates a board of directors.

• North Dakota’s HB 1126 passed both houses of the legislature on April 27 and Governor Dalrymple has said he supports the legislation. The bill authorizes the insurance department to work with the state human services department to plan the Exchange and allows the state to seek additional federal funding for the Exchange.

• Colorado’s SB 200 establishes the Exchange as a nonprofit public entity and creates a board of directors.  The bill passed the Senate, then House, and received final approval from the Senate on May 5. Governor Hickenlooper supports the legislation.

• Vermont’s H 202 establishes an Exchange under an existing state agency and creates the “Green Mountain Care” program designed to ultimately create a single-payer health system in the state. The bill passed both the House and Senate, and went to conference in order to reconcile different versions. The conference committee came to agreement and the bill received final approval on May 5. Governor Shumlin supports the legislation and is expected to sign it.

• Oregon’s SB 99 creates the Exchange as a public corporation and establishes a governing board of directors. The bill passed the Senate and now moves to the House.

Other states, like Arkansas and Mississippi, with legislatures that were unable to pass Exchange enabling legislation during their legislative sessions, are considering alternative options for establishing an Exchange, such as housing the Exchange within an existing program or issuing an executive order. In January, Indiana’s Governor Daniels issued an Executive Order establishing a state Exchange.
As states continue to work on Exchange enabling legislation or other establishment efforts they may find the following resources helpful:

• State Coverage Initiatives held a webinar on State Approaches to Health Benefit Exchange Legislation, featuring presentations from Nevada, Missouri and Maryland.
• The Center on Budget and Policy Priorities released resources that track Exchange legislation and analyze the various forms of governance.
• The Manhattan Institute published a paper on how a market-based health insurance Exchange can work within the Affordable Care Act in New York.

Is your state in the midst of deciding whether or not to establish an Exchange? Share your state’s work on your state’s milestone page on State Refor(u)m. To engage in a cross-state discussion about this milestone visit State Refor(u)m’s national discussion page.
UPDATE: On May 11, 2011, Washington’s Governor Gregoire signed SB 5445 into law. On May 9, North Dakota’s HB 1126 was signed into law.