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Health Reform Differs Across States: Report

Five states play no role in federal marketplace, Medicaid expansion, or insurance reform

MONDAY, Feb. 3, 2014 (HealthDay News) -- California is one of 10 states that have done the most to roll out provisions of the Affordable Care Act, according to a new Commonwealth Fund report. These states, including Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, New York, Oregon, and Vermont, have committed to implementing "the most significant aspects of health reform," the report states.

Texas, by contrast, is one of five states, including Alabama, Missouri, Oklahoma and Wyoming, with a hands-off approach to the health reform law. These states aren't enforcing health insurance market reforms established under law, they rely entirely on the federal HealthCare.gov marketplace to enroll eligible consumers in health plans and they have declined to expand Medicaid, explained the report released Friday. Other states fall somewhere in between.

Thirty-two states and the District of Columbia passed new legislation or implemented regulations to carry out at least one of the Affordable Care Act's health insurance market reforms. Seven states, including Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, Oregon, and Vermont, have "fully embraced" the three major components of health reform by implementing market reforms, establishing a state-based marketplace, and expanding Medicaid, the research team found. Sixteen states and the District of Columbia have established their own health insurance marketplaces or exchanges.

"It's very encouraging that nearly all states have taken some steps toward implementing or enforcing the Affordable Care Act," Sara Collins, the Commonwealth Fund's vice president for health insurance, said in a news release from the foundation. "However," Collins added, "it is concerning that some states have taken only limited action, or none at all, since their low-income and uninsured residents in particular may not be able to fully benefit from the law."

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