Policy & Research


Status of states’ action on implementing the Affordable Care Act

By M. Suzanne Schrandt, J.D. | March 22, 2012

It’s been two years since the Affordable Care Act was signed into law.

The Commonwealth Fund and the Kaiser Family Foundation each recently released reports about the wide variance in health reform implementation going on across the states. While some states have led the way on implementation, others have held back awaiting the Supreme Court’s decision and the 2012 election results.

The resources below show health reform activity in two different areas. One, the establishment of health insurance exchanges, and the other, the review or enactment of policy to ensure compliance with the ACA’s new insurance market rules. In both cases, Kansas is behind the majority of the states in terms of advancing health reform implementation.


Overview of State ACA Efforts

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Implementing the Affordable Care Act

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The Kaiser report highlights exchange-based activity across the states, showing that 14 states have already established an exchange and 23 more are studying options or making plans to create an exchange. Meanwhile, two states have decided to not pursue creating an exchange and 12 more—including Kansas—are not undertaking “any significant activity.”

View map of all state activity.

The Commonwealth Fund report instead looks at how states have gone about getting insurers up to speed with the ACA’s new insurance rules. Several new insurance requirements have already taken effect such as the prohibition on lifetime limits and the extension of dependent coverage to age 26. As such, the report shows that all but one state has taken steps toward ensuring compliance with these new rules.

The report also shows that 23 states enacted legislation or regulation related to one or more of these new insurance rules. An additional 15 states took what the report calls “sub-regulatory action” to encourage compliance with the laws, in the form of memoranda or bulletins to insurers. Finally, 11 states—including Kansas—did not take any official action but are reviewing existing policies to monitor for compliance.

Nearly 60 percent of Kansans have some form of private health insurance; that proportion is even larger—over 70 percent—for adults ages 19 – 64. Many of these privately insured Kansans will be, or have already been, affected by the ACA’s rules. See our recently released Annual Insurance Update for more information.