Here is a look at where each of the 50 states stand on implementing President Barack Obama’s federal health care overhaul, which the Supreme Court ruled Thursday can go forward with its aim of covering more than 30 million uninsured Americans.
NUMBER OF UNINSURED: 720,000 state residents are uninsured, or about 15.4 percent.
WHERE THE STATE STANDS: Republican Gov. Robert Bentley, a physician, created a commission in 2011 to recommend a plan for a health insurance exchange, but he successfully opposed efforts by some legislators to enact one in May. Critics said the bill would have limited the exchange to companies operating statewide, which is one at this point. Bentley said it was premature to act before the Supreme Court ruled.
NUMBER OF UNINSURED: 125,000 state residents are uninsured, or about 18 percent.
WHERE THE STATE STANDS: Alaska, which is among the states that sued over the constitutionality of the federal health care law, has yet to implement a health care exchange. The health department has hired a consultant to help design one, and that report is expected soon.
NUMBER OF UNINSURED: 1.28 million state residents not covered, or about 19 percent
WHERE THE STATE STANDS: Arizona is among the states challenging the constitutionality of the health care overhaul. The lawsuit covers about 22,000 people statewide, including some 14,000 people in the Phoenix area. Republican Gov. Jan Brewer’s administration is moving to implement part of the contested law by reviewing health insurance rates to see if they should be labeled unjustifiably high. The state also has accepted a federal grant to create a state health insurance exchange.
NUMBER OF UNINSURED: 539,000 state residents are uninsured, or about 19 percent.
WHERE THE STATE STANDS: Arkansas decided on a federal-state partnership for its health insurance marketplace. Legislators blocked a bill by which the state would have created its own insurance exchange but have since accepted a grant that will allow it to at least have a role in the federally created exchange.
NUMBER OF UNINSURED: NUMBER OF UNINSURED: 7,209,000 state residents are uninsured, or about 19 percent.
WHERE THE STATE STANDS: California has worked to be a model for the health care law and has begun implementing parts of it already, including creating the beginnings of health care exchanges to provide consumers a marketplace to purchase insurance policies starting in 2014. The state has also already banned insurers from refusing coverage for children with pre-existing illnesses and young adults are allowed to stay on their parents’ plans through age 26 in California.
NUMBER OF UNINSURED: 656,000 state residents are uninsured, or about 13 percent.
WHERE THE STATE STANDS: Colorado lawmakers passed legislation in 2011 to set up health insurance exchanges, and a commission is in the process of implementing them. The exchanges are set to start October 2013.
NUMBER OF UNINSURED: About 377,000 state residents are uninsured, or about 11 percent.
WHERE THE STATE STANDS: Connecticut has hired staff and a board of directors to begin implementing health care exchanges and have them in place by the 2014 deadline set by the federal law. The state already is allowing people under 26 years old to stay on their parents’ health insurance policies, which is part of the federal law.
NUMBER OF UNINSURED: Between 100,000 and 110,000 Delaware residents are uninsured, about 11 percent of the state’s population.
WHERE THE STATE STANDS: Delaware officials are working on a health care exchange. State officials also are accepting public input as they come up with minimum coverage requirements that must be included in health care plans for individuals and small businesses.
NUMBER OF UNINSURED: 3.85 million Floridians are uninsured, or about 21 percent.
WHERE THE STATE STANDS: Republican Gov. Rick Scott ordered the state not to accept federal money for implementing the health care law after he took office last year. Florida has rejected or declined to pursue more than $106 million and has returned $4.5 million. The state has its own health insurance exchanges, mainly for small businesses but without an individual mandate. The state has not implemented an exchange that would meet the requirements of the federal law.
NUMBER OF UNINSURED: 1,905,000 state residents are uninsured, or 19 percent.
WHERE THE STATE STANDS: Georgia has done nothing to implement a health care exchange. Lawmakers have introduced bills that would either allow or hinder implementation of the law, though none have passed.
NUMBER OF UNINSURED: 97,000 state residents are uninsured, or 7.7 percent.
WHERE THE STATE STANDS: Hawaii has been moving at full speed in anticipation the overhaul will be upheld. It joined several states last year in filing a friend-of-the-court brief in support of the law. Gov. Neil Abercrombie, a Democrat, said at the time the law preserved the best elements of Hawaii’s long-standing health care statutes. The state also used a $300,000 private grant to create a state job for a coordinator to implement the overhaul. Hawaii plans to develop its own insurance exchange, a key component of the federal overhaul.
NUMBER OF UNINSURED: 294,000 state residents are uninsured, or about 19 percent.
WHERE THE STATE STANDS: Idaho has not implemented health insurance exchanges, over objections from insurers including Blue Cross of Idaho. The GOP-controlled Idaho Legislature declined to accept federal grants for the project and also balked at putting together a scaled-down state-funded version while awaiting the Supreme Court’s decision.
NUMBER OF UNINSURED: 1,914,000 state residents are uninsured, or about 15 percent.
WHERE THE STATE STANDS: Illinois has received three federal grants to study and start building its health insurance exchange, but the Legislature has failed to pass a law establishing it. Gov. Pat Quinn, a Democrat, has considered an executive order to do that, but now may pursue a federal-state partnership instead.
NUMBER OF UNINSURED: 850,000 state residents are uninsured, or about 13.4 percent.
WHERE THE STATE STANDS: Republican Gov. Mitch Daniels ordered state agencies to build a framework for a possible exchange, but he has not implemented one pending the Supreme Court ruling. Indiana also has pushed to use its health savings account to help cover an estimated 500,000 who will become eligible for Medicaid in 2014 under the federal health care overhaul, but federal officials denied the request in September, saying it was premature.
NUMBER OF UNINSURED: 366,000 Iowa residents are uninsured, about 12 percent of the population.
WHERE THE STATE STANDS: The state does not have a law establishing a health insurance exchange, and Republican Gov. Terry Branstad has said Iowa will create a state-based exchange only if the law is upheld. The Republican House Majority leader says the state has already enacted several pieces of the law, including a website that helps residents find insurance, but the state has yet to comply with other requirements.
NUMBER OF UNINSURED: 350,000 state residents are uninsured, or almost 13 percent.
WHERE THE STATE STANDS: The Republican-dominated state government has been hostile to the 2010 federal law and hasn’t moved to set up a health care exchange. Last year, GOP Gov. Sam Brownback’s administration returned a $31.5 million federal grant.
NUMBER OF UNINSURED: 640,000 state residents are uninsured, or about 15 percent.
WHERE THE STATE STANDS: Kentucky has laid the groundwork for a statewide health insurance exchange, but Democratic Gov. Steve Beshear opted to wait for the Supreme Court ruling before moving doing anything more.
NUMBER OF UNINSURED: 886,000 state residents are uninsured, or about 20 percent.
WHERE THE STATE STANDS: Louisiana has not implemented health care exchanges, instead choosing to have the federal government create and operate them. Republican Gov. Bobby Jindal and Attorney General Buddy Caldwell oppose the health care law, and Louisiana is one of the states challenging it in court.
NUMBER OF UNINSURED: 121,000 state residents uninsured, or about 9.4 percent. The number may rise due to Medicaid cutbacks authorized by the latest state budget.
WHERE THE STATE STANDS: Maine had a task force to create a health care exchange, but legislation implementing one was set aside until after the Supreme Court’s decision. Maine has passed laws implementing components of the law, such allowing parents to add coverage of children up to age 26 and outlawing denial of insurance coverage due to pre-existing conditions. Maine has also passed a law that will allow consumers to shop out-of-state for coverage.
NUMBER OF UNINSURED: 747,000 state residents are uninsured, or about 13 percent.
WHERE THE STATE STANDS: Maryland has passed legislation to create a health care exchange, setting up standards and regulations to run the program and creating the framework for a marketplace where individuals and small businesses can purchase coverage.
NUMBER OF UNINSURED: Massachusetts says 120,000 people, or about 2 percent of the population, remained uninsured in 2010. The U.S. Census Bureau had a somewhat higher estimate of about 370,000 people, or more than 5 percent of the population.
WHERE THE STATE STANDS: Massachusetts passed a sweeping health care law in 2006 that became the blueprint for the federal overhaul. Many of the key elements of the federal law, including the “individual mandate” requiring nearly everyone have insurance, remain the law in Massachusetts.
NUMBER OF UNINSURED: 1.27 million Michigan residents are uninsured, about 13 percent of the population.
WHERE THE STATE STANDS: The Department of Licensing and Regulatory Affairs has been working to set up a health insurance exchange but has had limited success because House Republicans refuse to let it use $9.8 million in federal planning dollars. Because of looming federal deadlines to have an exchange in place, state officials are planning for a state-run exchange while also talking to federal officials about a possible partnership on a federal exchange where the state handles just some responsibilities, such as customer service.
NUMBER OF UNINSURED: 509,000 state residents are uninsured, or about 9.8 percent.
WHERE THE STATE STANDS: Minnesota has embraced the health care overhaul more than many states. Democratic Gov. Mark Dayton used a provision in the federal law to extend Medicaid coverage to more than 80,000 vulnerable adults as soon as he took office in 2011. His administration has focused on developing an online health insurance exchange envisioned as a key part of the law, securing $28.4 million from the federalgovernment for Minnesota’s planning efforts.
NUMBER OF UNINSURED: 618,000 state residents are uninsured, or about 21 percent.
WHERE THE STATE STANDS: Mississippi Insurance Commissioner Mike Chaney, a Republican, has been working on a health care exchange and has accepted federal money for the project. The exchange originally was proposed by Republican Haley Barbour when he was governor.
NUMBER OF UNINSURED: 835,000 state residents are uninsured, or about 14 percent.
WHERE THE STATE STANDS: Missouri received an initial planning grant but has not implemented a health insurance exchange because of opposition to it by some Republican state senators.