Individuals in states that ceded all enforcement of the Affordable Care Act were worse off by approximately $245 per 
participant on an annualized basis, according to a recent study from Amanda Kowalski, published by the Brookings Institution.
Kowalski labels Alabama, Missouri, Oklahoma, Texas and Wymoing as "direct enforcement" states, and notes that these states experienced smaller coverage increases over time. This is perhaps a result of sicker enrollees living in these states.
On the flip side, six of the eight states that successfully implemented both their own state-run exchanges and expanded Medicaid saw the welfare average improve drastically. New York, for instance, improved the average enrollee's welfare by $1,164 annually, Kowalski finds.
Arkansas and Kentucky were big winners this past enrollment period--both states, which ran their own exchanges and expanded Medicaid, recorded the largest reduction in uninsured residents, FierceHealthPayer previously reported.
States that experienced technical glitches--Hawaii, Maryland, Massachusetts, Minnesota, Nevada and Oregon--experienced bigger problems than states that built successful exchanges, finds Kowalski. Participants in these states were worse off by $750 annually, compared to those in successfully-run states.
"Market participants in the six states that had severe exchange glitches are worse off by approximately $750 per participant on an annualized basis, relative to participants in other states with their own exchanges," Kowalski writes.
State-based exchange glitches were, unfortunately, quite common since ACA implementation. Back in January, Maryland officials continued to struggled to make the state's health insurance exchange operable. And what's more, this left up to 5,000 people thinking they were fully enrolled, even when they weren't.
Yet states that were more more passive, meaning, the ones that did not implement the main elements of the healthcare reform law--were $330 better off annually compared to the glitchy states, according to Kowalski.
For more:
- here's the full report (.pdf)