Where states stand on implementing health care law
Jun 28, 2012, 8:11 PM
(AP) – A look at where the 50 states and the District of Columbia 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.
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ALABAMA
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 an online health insurance exchange, but he successfully opposed efforts by some legislators to enact one in May. Bentley had called it premature to act before the Supreme Court ruled. Critics said the bill would have limited the exchange to companies operating statewide, which is one at this point.
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ALASKA
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 an online health insurance exchange. The health department has hired a consultant to help design one, and that report is expected soon.
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ARIZONA
NUMBER OF UNINSURED: 1.28 million state residents are uninsured, or about 19 percent.
WHERE THE STATE STANDS: Arizona is among the states that challenged the constitutionality of the health care overhaul. Republican Gov. Jan Brewer’s administration has moved to implement part of the 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.
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ARKANSAS
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.
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CALIFORNIA
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, including creating the beginnings of health insurance exchanges to provide consumers a marketplace to purchase insurance policies starting in 2014. The state also has already banned insurers from refusing coverage for children with pre-existing illnesses and young adults already are allowed to stay on their parents’ plans through age 26 in California.
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COLORADO
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.
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CONNECTICUT
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 insurance 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.
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DELAWARE
NUMBER OF UNINSURED: Between 100,000 and 110,000 Delaware residents are uninsured, or about 11 percent.
WHERE THE STATE STANDS: Delaware officials are working on a health insurance 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.
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DISTRICT OF COLUMBIA
NUMBER OF UNINSURED: 76,000 district residents are uninsured, or about 12 percent.
WHERE THE DISTRICT STANDS: The district approved a law creating a health insurance exchange in December 2011 and is in the process of implementing it, with the goal to have it fully operational by the second half of 2013. The D.C. Council also has passed local laws allowing residents to stay on their parents’ insurance until age 26 and mandating that 80 percent of insurance premiums be spent on medical care.
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FLORIDA
NUMBER OF UNINSURED: 3.85 million state residents 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 insurance mandate for individuals. The state has not implemented an exchange that would meet the requirements of the federal law.
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GEORGIA
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 insurance exchange. Lawmakers have introduced bills that would either allow or hinder implementation of the law, though none have passed.
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HAWAII
NUMBER OF UNINSURED: 97,000 state residents are uninsured, or 7.7 percent.
WHERE THE STATE STANDS: Hawaii has been moving at full speed to implement the overhaul. 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 also plans to develop its own insurance exchange, a key component of the federal overhaul.
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IDAHO
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.
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ILLINOIS
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.
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INDIANA
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 an online health insurance marketplace, a cornerstone of the federal law, but it hasn’t been implemented. 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 overhaul, but federal officials denied the request in September, saying it was premature.
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IOWA
NUMBER OF UNINSURED: 366,000 Iowa residents are uninsured, or about 12 percent.
WHERE THE STATE STANDS: The state does not have a law establishing a health insurance exchange, but Republican Gov. Terry Branstad has said Iowa would create a state-based exchange if the law were upheld. The Republican House Majority leader says the state already has enacted several pieces of the law, including a website that helps residents find insurance, but the state has yet to comply with other requirements.
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KANSAS
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 an online health insurance marketplace. Last year, GOP Gov. Sam Brownback’s administration returned a $31.5 million federal grant given to help set up an exchange.
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KENTUCKY
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.
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LOUISIANA
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 was one of the states challenging it in court.
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MAINE
NUMBER OF UNINSURED: 121,000 state residents are uninsured, or about 9.4 percent.
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 as allowing parents to add coverage of children up to age 26 and outlawing denial of insurance coverage due to pre-existing conditions. Maine also has passed a law that will allow consumers to shop out-of-state for coverage.
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MARYLAND
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.
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MASSACHUSETTS
NUMBER OF UNINSURED: Massachusetts says 120,000 residents, or about 2 percent, were uninsured in 2010. The U.S. Census Bureau had a somewhat higher estimate of about 370,000 residents, or more than 5 percent.
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.
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MICHIGAN
NUMBER OF UNINSURED: 1.27 million state residents are uninsured, or about 13 percent.
WHERE THE STATE STANDS: The Department of Licensing and Regulatory Affairs has been working to set up an online health insurance marketplace, but has had limited success because House Republicans have refused to let it use $9.8 million in federal planning money. Because of looming federal deadlines to have the health insurance exchange in place, state officials have been planning for a state-run exchange while also talking to federal officials about partnering with a federal exchange where the state handles just some responsibilities, such as customer service.
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MINNESOTA
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 federal government for Minnesota’s planning efforts.
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MISSISSIPPI
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 insurance exchange and has accepted federal money for the project. The exchange originally was proposed by Republican Haley Barbour when he was governor.
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MISSOURI
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 an online health insurance exchange, a cornerstone of the federal law, because of opposition to it by some Republican state senators. Missouri residents will vote in November on a ballot measure asking whether Democratic Gov. Jay Nixon’s administration should be barred from implementing an insurance exchange without specific authority in state law.
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MONTANA
NUMBER OF UNINSURED: 176,000 state residents are uninsured, or about 18.1 percent.
WHERE THE STATE STANDS: Republican lawmakers in Montana who controlled the Legislature have rejected efforts to establish a health insurance exchange.
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NEBRASKA
NUMBER OF UNINSURED: 237,000 state residents are uninsured, about 13 percent.
WHERE THE STATE STANDS: The state does not have a law establishing an online health insurance exchange, a cornerstone of the federal law. However, Republican Gov. Dave Heineman has instructed the state Department of Insurance to plan for one.
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NEVADA
NUMBER OF UNINSURED: 563,000 state residents are uninsured, or about 21 percent.
WHERE THE STATE STANDS NOW: The Nevada Legislature in 2011 passed a bill implementing the Silver State Health Insurance Exchange and creating a seven-member board to oversee it. Republican Gov. Brian Sandoval opposed the federal health care law as a candidate. He also allowed a private attorney appointed by former Gov. Jim Gibbons to continue representing Nevada in the lawsuit filed by more than two dozen states challenging the law. State officials estimate the law will cost Nevada $575 million in the first five years as more people become eligible for Medicaid.
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NEW HAMPSHIRE
NUMBER OF UNINSURED: 134,000 state residents are uninsured, or just more than 10 percent.
WHERE THE STATE STANDS: New Hampshire currently has laws that echo portions of the federal overhaul, such as allowing dependent unmarried residents to remain on their parent’s health care insurance until age 26. Last year, state legislators passed laws that said residents cannot be required to obtain health insurance or be fined for not being covered. They also established a state oversight committee that must give its OK before the federal law is implemented. Democratic Gov. John Lynch’s office said it put implementation plans on hold until the Supreme Court ruling.
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NEW JERSEY
NUMBER OF UNINSURED: 1.3 million state residents are uninsured, or about 15 percent.
WHERE THE STATE STANDS: The Legislature passed a law to set up a state health insurance exchange, but Republican Gov. Chris Christie vetoed the measure in May, saying he did not want to spend money on something that was being challenged in court.
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NEW MEXICO
NUMBER OF UNINSURED: 433,000 state residents are uninsured, or about 21 percent.
WHERE THE STATE STANDS: New Mexico this week announced formation of a task force to develop a proposal for creating a state health insurance exchange. Republican Gov. Susana Martinez’s administration also is working on an overhaul of Medicaid to try to slow the growth of the program without cutting enrollment or changing who’s eligible to receive medical services. The state wants to have the revamped Medicaid program implemented in the fall of 2013.
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NEW YORK
NUMBER OF UNINSURED: 2,886,000 state residents are uninsured, or about 15 percent.
WHERE THE STATE STANDS: Democratic Gov. Andrew Cuomo issued an executive order April 12 to establish a statewide health insurance exchange, where individuals and small businesses could tap up to $2.6 billion in federal tax credits and subsidies, planning to show by January that the state is ready to participate, start taking applications the following October and start operating Jan. 1, 2014.
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NORTH CAROLINA
NUMBER OF UNINSURED: 1.57 million state residents are uninsured, or about 17 percent.
WHERE THE STATE STANDS: Legislation aimed at prohibiting the mandate for individuals to buy health insurance was the first item introduced after Republicans took over control of by North Carolina’s General Assembly last year. Lawmakers haven’t been able to overcome Democratic Gov. Beverly Perdue’s veto of their bill. But work to design health insurance exchanges has stalled since last summer.
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NORTH DAKOTA
NUMBER OF UNINSURED: 83,000 state residents, or about 13 percent, had no health insurance in 2010.
WHERE THE STATE STANDS: Legislators last year rejected a state-run online health insurance exchange. Majority Republicans at the time called the insurance exchange too complex and too expensive to put into place.
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OHIO
NUMBER OF UNINSURED: More than 1.5 million state residents are uninsured, or about 14 percent.
WHERE THE STATE STANDS: Ohio has not moved to create a health care exchange but is evaluating its options. It received a $1 million federal exchange planning grant in 2010. Republican Gov. John Kasich’s administration has taken advantage of some parts of the new law to expand coordinated care and propose changes to Medicaid eligibility. Democrats have unsuccessfully pushed bills in the Legislature to set up a state-run exchange. But Lt. Gov. Mary Taylor, who is also Ohio’s insurance director, has frequently criticized the overhaul and said it was premature to plan for an exchange without further clarification from the federal government.
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OKLAHOMA
NUMBER OF UNINSURED: 624,480 state residents are uninsured, or about 17 percent.
WHERE THE STATE STANDS: Oklahoma lawmakers first rejected $54 million in federal funding to create an online health insurance marketplace and then decided to take no action on developing the exchange, deciding instead to wait on the court’s ruling.
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OREGON
NUMBER OF UNINSURED: 612,000 state residents are uninsured, or about 16 percent.
WHERE THE STATE STANDS: Oregon is working aggressively to implement the health care law and is further along than most other states. The federal government has committed more than $60 million in grants to develop a health insurance exchange that could be duplicated in other states.
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PENNSYLVANIA
NUMBER OF UNINSURED: 1.37 million state residents are uninsured, or about 11 percent.
WHERE THE STATE STANDS: Republican Gov. Tom Corbett, as state attorney general in 2010, joined a group of state officials in challenging the law. Still, Pennsylvania is working to set up a health insurance exchange required by the law, although the state Insurance Department said it was waiting for the Supreme Court’s decision before touching a $33 million grant it won in January to build out the exchange.
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RHODE ISLAND
NUMBER OF UNINSURED: 119,000 state residents are uninsured, or about 11.4 percent.
WHERE THE STATE STANDS: Rhode Island has received $58 million in federal funds to assist in the creation of its health insurance exchange. Gov. Lincoln Chafee, an independent, last week picked a former state health official to direct the exchange.
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SOUTH CAROLINA
NUMBER OF UNINSURED: 930,000 state residents are uninsured, or more than 20 percent.
WHERE THE STATE STANDS: South Carolina, which is among the states that sued over the constitutionality of the federal health care law, opted not to implement health care exchanges after a panel concluded there were too many unanswered questions.
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SOUTH DAKOTA
NUMBER OF UNINSURED: Federal officials estimate 105,000 state residents are uninsured, or about 13 percent; South Dakota officials say state survey data is lower, about 9 percent.
WHERE THE STATE STANDS: Republican Gov. Dennis Daugaard delayed work on setting up a health insurance exchange until after the court’s decision and wants to wait until after the November presidential election to decide what to do about the online marketplace or whether the state will expand its Medicaid program.
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TENNESSEE
NUMBER OF UNINSURED: 930,000 state residents are uninsured, or 15 percent.
WHERE THE STATE STANDS: Tennessee has laid the groundwork for a health insurance exchange but would have to wait until the Legislature returns in January to complete it.
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TEXAS
NUMBER OF UNINSURED: 6.2 million state residents are uninsured, or about 25 percent.
WHERE THE STATE STANDS: Texas has not implemented an online health insurance marketplace. But the Texas Health and Human Services Commission, which oversees Medicaid in the state, says the agency already has met deadlines for some requirements, such as implementing a tobacco cessation benefit for pregnant women on Medicaid. In addition, at least 5,700 Texans are participating in a federally mandated insurance plan for those with pre-existing conditions, though the U.S. Department of Health and Human Services is running that program instead of Texas.
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UTAH
NUMBER OF UNINSURED: 386,000 state residents are uninsured, or nearly 14 percent.
WHERE THE STATE STANDS: Utah implemented a health insurance exchange before the federal law was passed to help small businesses obtain insurance coverage for their employees, but was among 26 states that sued the federal government over the law.
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VERMONT
NUMBER OF UNINSURED: 59,000 state residents are uninsured, or about 9.5 percent.
WHERE THE STATE STANDS: Vermont in 2011 passed legislation to use the health insurance exchange called for under the federal health care law as a springboard to launch a statewide, universal, publicly funded health care system by 2017.
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VIRGINIA
NUMBER OF UNINSURED: Nearly 1.1 million state residents are uninsured, or about 14 percent.
WHERE THE STATE STANDS: Virginia has expressed its intent to create a health insurance exchange, but Republican Gov. Bob McDonnell has not acted on recommendations made by a gubernatorial advisory council. Virginia filed its own lawsuit challenging the health care law, but lost in federal appeals court.
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WASHINGTON
NUMBER OF UNINSURED: 927,000 state residents are uninsured, or about 13.8 percent
WHERE THE STATE STANDS: Republican Attorney General Rob McKenna signed on to the health care lawsuit against the wishes of the state’s Democratic governor and majority Democrats, but Washington state moved ahead this past legislative session with implementing its own health insurance exchange.
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WEST VIRGINIA
NUMBER OF UNINSURED: 244,000 West Virginians are uninsured, or about 13.5 percent.
WHERE THE STATE STANDS: West Virginia has enacted legislation allowing for a state-run health insurance exchange, but the state has slowed the pace of setting it up to see how the Supreme Court rules.
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WISCONSIN
NUMBER OF UNINSURED: 526,000 state residents are uninsured, or about 9 percent.
WHERE THE STATE STANDS: Wisconsin has not begun setting up its health insurance exchange. Work on that was put on hold in January by Republican Gov. Scott Walker, who has vowed not to implement any part of the law ahead of the November election.
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WYOMING
NUMBER OF UNINSURED: 93,000 state residents are uninsured, or about 17 percent.
WHERE THE STATE STANDS: Wyoming has not implemented health care exchanges, but a steering committee is studying an exchange for Wyoming and will present a report to the Legislature this fall.
(Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)
