Despite attempts by the Trump administration and Republican-controlled Congress to dismantle the Affordable Care Act, blue states are fighting back to prop up the 2010 law.
New Jersey is nearly set to implement its own individual mandate for health care coverage after Congress rolled back the requirement at the federal level. The New Jersey Health Insurance Market Preservation Act, passed last week, would require people without insurance to pay a fine of 2.5% of their household income, or $695 per adult and $357 per child.
The bill now goes to Gov. Phil Murphy's desk for signature.
At the same time, Maryland's governor and state lawmakers finalized legislation to prevent a potential marketplace collapse.
The Maryland Health Care Access Act of 2018 extracts $380 million in fees from insurers, once required under the ACA, and is expected to keep the state's exchanges afloat, which cover about 150,000 people.
Maryland's fix is only temporary, however, and many complex issues remain, including ever-increasing insurance premiums.
The Department of Health and Human Services has also taken many steps to undermine the exchanges, recently announcing it would relax essential health benefits that compliant plans are required to cover. Centers for Medicare & Medicaid Services Administrator Seema Verma said the changes would give states more flexibility, but once again called on Congress to fully repeal the law.
Meanwhile, the agency has laid out a plan to end the federal exchanges by 2020 if Congress can follow through with a repeal.
New Jersey and Maryland's legislative feats could be a harbinger of things to come in other states, and could set up political battle lines ahead of the 2018 midterms where 36 gubernatorial elections are up for grabs.