Va., most other states lag behind Md. in setting up new health exchanges

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NCSL logoBy Sam Smith

Maryland has firmly established its Health Benefit Exchange under Obamacare and has a long-term plan in place. But 40 states, including Virginia, have not passed legislation authorizing a health benefit exchanges in their borders as required by the Affordable Care Act of 2010.

States have one more week to present a state-facilitated exchange blueprint before the Dec. 14 federal deadline. States also have the option to default to a federally-run program or create a state-federal partnership.

The exchange is designed to allow Marylanders to compare rates, benefits, and quality among plans to help individuals and small employers find an insurance product that best suits their needs.

In a panel Thursday at the Washington meeting of the National Conference of State Legislatures, Virginia’s Secretary of Health and Human Services agreed with many other state legislators in attendance that Virginia is divided about creating an exchange. Unlike Maryland’s embrace of the Affordable Care Act, Virginia was one of two dozen states that sued to block it.

Virginia won’t meet deadline

“I don’t think we can build a state-based exchange, so on December the 14th we will say we can’t do that,” Hazel said. “I believe that through June of last year we were probably as far along as any state in our preparations to build an exchange. Right now due to the uncertainty and the unknowns, we made a decision that we were going to sit and wait for questions to be answered.”

Maryland is a national model for the implementation of an exchange program. It has passed two laws in the past two years that have established its exchange as a public corporation and an independent unit of state government. The state has also received four federal grants for the exchange including one for $123 million in August.

Maryland is one of six states, along with Washington D.C., to have received Level Two Establishment grant funding, which fund planning and implementation in the first year of operation. They were approved in August.

In order to receive the level two grant, states must show that their exchanges have legal authority. Maryland’s exchange has had this power since 2011, when it passed the Maryland Health Benefit Exchange Act of 2011 which also created the exchange’s board of trustees.

Maryland ahead of the game  

On the NCSL panel, Maryland Health Benefit Exchange Policy Director Frank Kolb said in creating an exchange, it is imperative to create an open and transparent process in which stakeholder interests are taken into consideration. That is something he said Maryland has been doing long before he took the position of the exchange’s policy director.

“When I was doing the research about the opportunity [to work in Maryland], I was just impressed with how far along Maryland was just in general,” Kolb said. “They had already been through a year and a half of public hearings with advocates and industry folk along the way.”

Kolb said another big reason why Maryland is ahead of other states with its exchange is due to the early action by state leaders.

“I think that the fact that we were able to have such good guidance coming straight out with the legislators and the governor’s office,” Kolb said. “I think a lot of it was willingness to open the doors early.”

About The Author

Len Lazarick

Len Lazarick was the founding editor and publisher of and is currently the president of its nonprofit corporation and chairman of its board He was formerly the State House bureau chief of the daily Baltimore Examiner from its start in April 2006 to its demise in February 2009. He was a copy editor on the national desk of the Washington Post for eight years before that, and has spent decades covering Maryland politics and government.


  1. brain dead in MD

    NOT a good thing being the first state to embrace socialism!! So much for the FREE STATE unless of course you mean ‘HANDOUT STATE!!’

  2. cwals99

    For all that think Maryland’s having their health exchange in place is a good thing…..think twice. Johns Hopkins drives health reform in Maryland and as such made sure it was a private health system rather than a public. This means that private health industry people have been meeting to figure out how to make health care more affordable and how to handled cuts in entitlements without hurting corporate profits. The answer is simple….cut access and patient services and quality of care. If there had been a public health system we would have seen an extension of an already established and well-functioning (except for the massive fraud resulting from absolutely no oversight) health system that worked in the public interest with equal access without regard to corporate profit. Come on now…which sounds better.

    Since Maryland is a corporate state and since Johns Hopkins stands to become a global enterprise that will be fabulously rich, you can see why O’Malley and the Maryland Assembly went that way. What it means for you and me….we will see most people fall into the category of ‘catastrophic’ health insurance and Medicaid both of which is being made to resemble public health care in third world countries. This ‘preventive’ approach is simple a gimmick for seeming to provide care when all they are doing is making sure no communicable disease…..whooping cough, polio, HIV etc….. is present. The way these corporate pols are going only about 20% of Americans will have the same quality care we have now because they are the ones who will be able to afford to pay the health premiums, deductibles, and co-pays. Businesses are shedding their policies so finding a company with health care benefits will be hard and wages are so low as to make buying a plan impossible.

    We can turn this around by electing fiscal progressives instead of Third Way corporate democrats. Fiscal progressive support the public health system and can tell Hopkins to take a walk!!

    • Dale McNamee

      Well, you can thank your ” lord & savior” Barack Obama for what happens… He rammed this into law, it’s his “baby” ! Equally poor healthcare for all !


  3. Carol Macht

    Of course Maryland rapidly embraces socialism, faster than anyone – congrats!

  4. Suprsvc01

    Nothing like being on the bleeding edge.

    • Karl

      Everything I read indicates that those 40 states are not funding Obama Care intentionally. Consequently there may be a great disparity for services depending upon where the recipients reside.

      • Dale McNamee


        I was in Canada a few years back and the quality of medical services VARIED greatly from province to province ! This is what socialized medicine ( Obamacare) will bring !

        Socialism always reduces people to living miserable lives ( fair & bequal) unless you are the “ruling elite” ( Government employees, Senators & Congressmen, Hollywood, academia ) !

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