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  October 29, 2012
Third Party System

What's the Status of Each State's Health Care Exchange?

By dba Staff

Update: As of December 14, 2012, this is how each state has decided to Implement Their "Affordable Insurance Exchanges."

Now that the Supreme Court has determined that the Patient Protection and Affordable Care Act (ACA) is constitutional, many states are in the midst of establishing exchanges through which individuals and small businesses with up to 50 full-time employees will be able to purchase health insurance. Federal law mandates that these exchanges must be certified and operational by Jan. 1, 2014.

A total of 34 states, and the District of Columbia, have either already established an exchange (Calif., Colo., Conn., D.C., Hawaii, Ky., Md., Mass., Nev., N.Y., Ore., R.I., Utah, Vt., Wash., W.Va.), are planning to create an exchange in partnership with the federal government (Ark., Del., Ill.) or are studying their options (Ala., Ariz., Idaho, Ind., Iowa, Mich., Minn., Miss., Mont., Neb., N.J., N.M., N.C., Pa., Tenn., Va.).

Of the remaining 16 states, eight have taken no significant activity toward creating an exchange (Ga., Kan., Mo., N.D., Ohio, Okla., Wis., Wyo.), while eight other states have already decided not to create an exchange (Alaska, Fla., La., Maine, N.H., S.C., S.D., Texas), in which case theirs will be managed by the federal government.

At least six states have indicated that they will put any decisions on hold until after the November elections (Ala., Ga., Kan., Mo., Neb., N.J.)

Qualified health plans selling insurance through these exchanges must include the 10 essential health benefits as defined by ACA. Among these are pediatric vision benefits.

How Will They Handle Stand-Alone Vision Plans?
While the federal law does not include a provision to allow stand-alone vision plans to sell directly through the exchanges, the U.S. Department of Health and Human Services has left it up to each state to decide whether it will allow stand-alone vision plans to directly participate in the exchanges or whether they will only be allowed to sell in partnership with a health plan that has been qualified to sell all 10 essential health benefits.

Currently, three states, Maryland, Massachusetts and Nevada, have committed to allowing stand-alone vision plans to directly participate in their exchanges. In other states, the debate over whether or not to allow stand-alone vision plans to participate directly in the insurance exchanges rages on.

For example, the optometric associations of Arizona, California, Hawaii and the District of Columbia have voted in support of stand-alone vision plans. Opposing them, the American Optometric Association has come out against allowing stand-alone vision plans from directly participating in each state's exchange, in a battle it has fought with VSP, the country's largest provider of stand-alone vision plans.

In California, home of VSP, the exchange board first decided to disallow stand-alone vision plans from directly participating in its insurance exchange, but it is now reconsidering that decision with a determination expected at its next meeting on Oct. 30. (Update: On October 30, the California Health Benefit Exchange voted unanimously to allow stand-alone vision plans to participate directly in both the individual and small business exchanges.)

What's Next?
With the law requiring that all states be on track for achieving certification of an exchange by Jan. 1, 2013, and have an operational exchange in place exactly one year later, at this point, every state should be close to determining how it will manage its exchange and whether or not it will allow stand-alone vision plans to directly participate.

What does this mean for mid-size regional and local optical chains? To paraphrase Nancy Pelosi who, before ACA was signed into law, said, "…we have to pass the [health care] bill so that you can find out what's in it…," we're unlikely to know what the outcome will be until the law actually goes into effect. What we do know is that an estimated 32 million currently uninsured Americans will have coverage, and an estimated 9 million to 10 million of them will be children who previously did not have health insurance in general and vision care specifically.

The Henry J. Kaiser Family Foundation's website.
National Association of Vision Care Plans presentation at Opti-Port's annual member conference during Vision Expo West. An Online Network for Health Reform Implementation
The U.S. Department of Health and Human Services
The Vision Council


Nine State Exchange Websites
Of the 16 states that have already established an exchange, the following nine have already created websites for them:

California California Health Benefit Exchange
Colorado Colorado Health Insurance Exchange
Connecticut Health Insurance Exchange
Hawaii Hawai'i Health Connector
Massachusetts Health Connector
Nevada Silver State Health Insurance Exchange
Utah Utah Health Exchange
Washington Washington State Health Care Authority
West Virginia West Virginia Health Benefit Exchange

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