Just yesterday I noted that the Michigan state senate has passed a bill to establish a state-based ACA exchange, joining 21 other states (Georgia is scheduled to launch theirs this fall, and Illinois in time for the 2026 Open Enrollment Period). The bill now moves to the state House, where I'm expecting it to pass and be signed into law by Gov. Whitmer without too much controversy. If so, Michigan would also split off of the federal exchange in time for the 2026 OEP.
Well, it turns out that another state may end up beating Michigan to the punch, and it's probably the last state you'd expect it to happen in: Mississippi!
A few weeks ago I noted the following press release from Democratic Virginia Governor Ralph Northam, just ahead of the critical state legislative elections:
Governor Northam Signs Executive Directive to Ensure Access to Affordable, Quality Health Care Coverage for All Virginians
“Health coverage should be both meaningful and affordable, but unfortunately, policies from Washington threaten to increase the number of families who are uninsured or underinsured,” said Governor Northam. “It’s more important than ever that we identify and implement policies at the state level that control costs and ensure that Virginians can afford to buy health insurance that covers their health care needs.”
New Analysis Finds Leading State-Based Marketplaces Have Performed Well, and Highlights the Impact of the Federal Mandate Penalty Removal
The report examines the impact that federal and state actions have had on state-based marketplaces and the federally facilitated marketplace (FFM).
Cumulative premium increases in California, Massachusetts and Washington are less than half of the increases seen in FFM states, but 2019 premium increases spiked in California and Washington compared to Massachusetts, which continued its state-based penalty.
WASHINGTON D.C. — A new report highlights the benefits of state-based exchanges, particularly in the areas of controlling premium costs and attracting new enrollment. The report, which was produced by Covered California, the Massachusetts Health Connector and the Washington Health Benefit Exchange, found that premiums in these states were less than half of what consumers saw in the 39 states that relied on the federally facilitated marketplace (FFM) between 2014 and 2019.
It's been pretty obvious for the past two years that the states which fully control their own ACA exchanges (including their own marketing and outreach budgets and their own exchange website platform) seem to be outperforming the states hosted by the federal exchange, HealthCare.Gov, in terms of open enrollment numbers year after year.
However, this can be a bit tricky to compare because some of the states have shifted back and forth...four states which ran their own platform for the first one to three years (Hawaii, Kentucky, Nevada and Oregon) moved home to the mothership in later years, while one state (Idaho) did the reverse--they stuck with HC.gov for 2014 but then broke off onto their own platform after that.
