What states matter most to exchange enrollment, Medicaid expansion?

Ten states are crucial to the Obama administration's ability to enroll 6 million people in health insurance exchanges by the end of the month.

Those states--California, Texas, Florida, New York, Georgia, Illinois, North Carolina, Ohio, Pennsylvania and New Jersey--account for nearly two-thirds (30 million) of the nation's 47 million uninsured consumers, reported Kaiser Health News.

Some of those states, namely California, New York, Florida and North Carolina, have seen higher enrollments. California, for example, has one of the most successful state-based exchanges. It has enrolled 1 million people as of last week, which is more than 30 percent of exchange-eligible residents.           

But other states, such as Texas, have far fewer exchange enrollees. Despite having 6.2 million uninsured Texans, less than 10 percent of those eligible for exchange plans enrolled as of March 1.

State exchange directors have tried to explain the wide variation in enrollment numbers. "This is about changing a culture that for too many low-income people is a culture of coping rather than a culture of coverage," Covered California CEO Peter Lee told KHN.

Meanwhile, six states still are undecided about whether they'll expand Medicaid, another key factor for succeeding in the post-reform market. State officials in New Hampshire, Virginia, Pennsylvania, Utah, Missouri and Indiana are considering several issues, including negotiating with the federal government, National Journal reported.

But Medicaid expansion decision isn't a simple yes or no decision; instead, lawmakers have to reach a consensus with each other as well as with the governor, and they all "can have subtly or radically different ideas of what they want done," Matt Salo, executive director of the National Association of Medicaid Directors, told the National Journal.

What's more, these remaining states are interested in tailored approaches to Medicaid expansion. Indiana, for example, is seeking federal approval to expand Medicaid by using a high-deductible health plan with a health savings account. And Pennsylvania wants to tie Medicaid coverage with certain work requirements for members.

"A lot of states are sitting on the sidelines at the moment and trying see if they can get a better sense of how far the administration is willing to come," Salo added.

To learn more:
- read the Kaiser Health News article
- see the National Journal article