Analysis: Implementing The Affordable Care Act In Maryland, Virginia

In the wake of Thursday's Supreme Court decision upholding the Affordable Care Act, local leaders are left to determine how to move forward with implementation of the law. Maryland and Virginia have taken different paths  in preparing for the overhaul, and they may well take different paths moving forward. Andy Hyman, a coverage team director for the Robert Wood Johnson Foundation has worked with both states on implementing the health care law, joins WAMU 88.5 All Things Considered host Pat Brogan to discuss.

Maryland has been aggressive about implementing the law, what does this mean for them?

"This provides tremendous comfort to the state. They've been working tirelessly to be prepared to implement the law — to expand coverage for the people of Maryland. Now, this gives them a real shot in the arm. They were going forward, but they were doing it with a great sense of uncertainty. This brings great clarity, and now they can move forward with their work."

What about Virginia? How well positioned is the Commonwealth?

"They have been cautious. The governor, particularly, has expressed great concern about the law. Nonetheless, they have prepared, because the alternative for them is that the federal government would take responsibility for implementing key provisions of the law, and they would certainly want to do it themselves."

"Now, with the framework of the law being validated by the Supreme Court, they know what's coming, and they want to be prepared in the event that the law stands. They want to be prepared for Jan. 1, 2014, when it all goes into effect."

Is the federal government prepared to take over for states that aren't ready?

"Under the Affordable Care Act, the federal government is obligated to create this new health insurance marketplace and exchange in the event that state governments don't step up to do that. So the federal government, like the states, is getting ready to create what is known as a 'federally-facilitated exchange,' to do this for the states that are not able to get theirs up and running in time. With respect to Virginia, I think they will be moving, and I think they'll be able to do it on their own."

How would you compare Maryland and Virginia to other states when it comes to implementation?

"Virginia and Maryland are different, as we described. Maryland, for example, has passed legislation to create the exchange already and has a board in place. Virginia hasn't done that yet."

"That's kind of what you see across the country. We work in states across the country that have different politics, demographics, geographically varied. They run the gamut in terms of being prepared. Now, with the law being validated, I think this will be a shot in the arm for all states."

The Supreme Court did rule that states can opt out of Medicaid expansion. How big an impact will that have in Maryland and Virginia?

"Clearly that's going to be up to the states themselves. It's one of the interesting twists in the court's opinion. The Medicaid expansion is really half of the expansion in coverage for the uninsured, so it's really important that states advantage of this. In Maryland, more than 200,000 people would be covered under Medicaid. In Virginia, it's far more — almost 400,000 people. Now the governors of both states are going to have to decide whether to exercise this option."