With a special session of the Florida legislature underway to adopt a state budget for the next fiscal year that begins July 1, federalism questions abound. Florida Gov. Rick Scott filed a lawsuit against the Obama administration in April, challenging what Florida Attorney General Pam Bondi characterized in an April 28 press release as “the federal government’s attempt to coerce Florida into expanding Medicaid” by withholding federal funding for hospitals that provide care to the uninsured. The federal government had notified Florida it would withhold $2.2 billion in funding for Florida hospitals in fiscal year 2016.

The Cleveland Clinic, one of the nation’s largest hospitals, reported a 40 percent drop in charity care and credited the good news to Ohio’s Medicaid expansion, according to Kaiser Health News. Free care costs fell from $171 million in 2013 to $101 million in 2014.

One of every 30 people living in 25 states that have declined the option to expand Medicaid eligibility will likely remain uninsured, according to CSG calculations. CSG analyzed data from a new Kaiser Family Foundation report that estimated 5 million low-income adults would fall into a coverage gap, where they would remain uninsured as they are not eligible for Medicaid under their states’ current rules and will not qualify for the new federal tax subsidy to make insurance purchase affordable beginning January 1, 2014.

As the percent of the population with health insurance coverage has fallen—from 86.5 percent in 2001 to 83.7 percent in 2010, according to the U.S. Census Bureau—the focus on coverage has become more acute.

According to the Census Bureau, 49.9 million people – or around 16.3 percent of the U.S. population – were without health insurance coverage in 2010. The percentage of the population that is uninsured that has been dropping for 10 years.  The percentage of insured residents ranges significantly across states, regions, age groups, racial and ethnic groups and income levels.

This brief from the Midwestern Legislative Conference Health and Human Services Committee explores what actions states must take this year in order to set up health insurance exchanges.

The Affordable Care Act mandates that states operate insurance exchanges to enable every citizen across the country to purchase or renew health insurance. The reform legislation provides federal support for “necessary” expenses so states can plan, establish and operate the exchanges for the first year of 2014. Although it specifies several conditions that insurance products offered through the exchange must meet, it allows the states great flexibility in determining how they will regulate and how much reform they will introduce for their state insurance market. Read about what health insurance exchanges can accomplish, how state Medicaid programs will be involved and what decisions states are facing in 2011 and 2012 related to health insurance exchanges.

Grant opportunities will be available through 2015 as long as states meet certain benchmarks along the way, Joel Ario, the Department for Health and Human Services official in charge of implementing the health insurance exchange provisions of the Affordable Care Act, told attendees at a webinar powered by The Council of State Governments Knowledge Center. 

Joel Ario acknowledges states face unprecedented hard fiscal times. But Ario said grants are available to help states implement the federal Affordable Care Act Congress passed in 2009 to reform health care.

Joel Ario, DHHS Director of the Office of Health Insurance Exchanges, will be available to take questions from state officials during CSG webinars scheduled this month. By January 1, 2014, all states must be operating health insurance exchanges under the Affordable Care Act. The exchanges will serve as marketplaces for small businesses and individuals to purchase insurance. States will be required to integrate the exchanges with Medicaid eligibility and application procedures.

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