These Five States Aren’t Lifting A Finger To Implement Obamacare


On January 1, 2014, most major provisions of the Affordable Care Act officially went into effect throughout America. Nonetheless, five red states are doing their best to ignore the reality of Obamacare, forgoing every one of the health law’s major reforms and refusing to enforce or oversee even its most basic consumer protections, according to a new analysis by the Commonwealth Fund.

Most states are tackling at least one of the ACA’s three major components: enforcing its market reforms and consumer protections, establishing a state-run insurance marketplace, and agreeing to its optional Medicaid expansion. Seven states have taken charge of all three. However, the researchers write, “[a]t the other end, five states — Alabama, Missouri, Oklahoma, Texas, and Wyoming — declined to play a role in implementing the law’s three major components. These states will not enforce the market reforms, will have a federally facilitated marketplace where the state will play no formal role, and declined to expand Medicaid.”

These five states’ decision not to run their own marketplaces isn’t uncommon, considering that 36 states have defaulted to a federal exchange. Rejecting the Medicaid expansion is somewhat more rare, since 26 states and the District of Columbia have already opted for it and several others could still do so in 2014. But the fact that these states won’t even oversee basic consumer protections and reforms through local regulatory agencies suggests a desire to be a total dead-end when it comes to health reform.

Federal officials will have to fill in the regulatory gaps in those places. But that could become a big hassle for consumers who are trying to enroll in new health plans. If these Americans run into problems or have complaints about the enrollment process, or believe they’re being bilked by an insurer, they would have to contact the Centers for Medicare & Medicaid Services (CMS) rather than their state’s insurance department.

Health policy experts say that regulating the market reforms within each state is much more efficient and a better deal for consumers. Several of these states, including Texas, have claimed they have no authority to enforce the rules since they don’t have corresponding state laws on the books — an argument that’s been met with considerable derision by public policy experts who point out that rationale hasn’t stopped the Lone Star State from implementing plenty of other federal laws.

The study authors end by raising the very types of questions that Americans in these five states are likely to encounter.

“What level of coordination will be required between state and federal regulators to ensure that the market reforms are enforced consistently in both the inside and outside markets? Where should consumers in each state turn to raise issues or ask questions about their coverage?” asked the researchers. “How will these changes affect critical outcomes, such as enrollment, cost, and marketplace sustainability? And, for those states that chose not to expand Medicaid, will policymakers adopt other mechanisms to provide coverage for low-income consumers or will these individuals be left without access?”