By Joe Touschner

Don’t believe everything you read in the newspaper — while the national media has reported that states are moving “gingerly” to implement the Affordable Care Act, in fact there’s been a great deal of activity of late, especially around exchanges.  No fewer than 16 state legislatures have acted favorably on measures that contribute to exchange implementation.  Here’s where we stand today:

• In seven states, exchanges are now state law.  California, Colorado, Hawaii, Maryland, Vermont, Washington, and West Virginia have enacted exchange legislation and created governing structures
• Connecticut, Nevada, and Oregon are right behind–legislatures in these three states have sent exchange bills to their governors’ desks
• Two more states–North Dakota and Virginia–have enacted legislation (with Republican governors’ signatures) declaring that they will set up exchanges, with the governance details to be worked out later
• In Illinois, Mississippi, Utah, and Wyoming, legislatures voted to move forward with a study of the issues around exchanges
• A number of other legislatures are actively debating exchange bills, such as in Rhode Island and New York
• And, of course, Massachusetts and Utah have exchanges that pre-date the Affordable Care Act–they’ll each need to make some changes to align their efforts with the ACA, but they’re several steps down the path already

Even before exchange laws are on the books, in many states agency staff, commissions, work groups, or task forces are deep into the process of planning exchanges.  Forty-nine states and DC received the first round of Exchange Planning Grants under the ACA (Alaska is the only state that has not).   Already, Indiana, Rhode Island, and Washington have received multi-million dollar grants to take their exchange planning to the next level with Establishment Grants.  And six states–Kansas, Maryland, New York, Oregon, and Wisconsin and a consortium of New England states led by Massachusetts, –have received even larger awards to take the lead in developing technology to power the exchanges.  These states have chosen to be Early Innovators who will develop new systems that can be shared with other states.  Oklahoma was also awarded an Early Innovator grant but has announced that it will not proceed with the project.  

In addition to this funding activity, the National Conference of State Legislatures reports that 31 states, DC, and the Virgin Islands have convened one or more groups to study and report on the ACA, so there are a lot of good minds at work in the states making exchange plans.   

The law is not yet 15 months old, and we’ve got another 18 months before the January 1, 2013 date when the Secretary of HHS must determine whether states are on track for having an operational exchange by 2014.  There’s still a lot of work to do to make sure fully-functioning exchanges are available for every American who qualifies, but the progress so far is real.  And we certainly look forward to seeing it accelerate in the next year and a half as dedicated advocates and state officials build this important new coverage source.