Enhancing the State Health Insurance Markets

State Progress Reports

The Affordable Care Act (ACA) insurance market reforms, coverage expansions, and subsidies are significant steps forward for the patient community. The successful implementation of these steps relies on states to continue and even expand their role as regulators of the health insurance market. State support is critical to guaranteeing the ACA's goals of high-quality and affordable health care for all.

The National Health Council (NHC) created state-specific progress reports to assess the patient-centeredness of health insurance markets across states. These reports show the variability across insurance marketplaces and identify states where changes could improve access to coverage and care for patients. These reports also can identify leading states that set best practices for patient-friendly requirements. 


Every state in the country has taken action; some states have emerged as leaders in implmenting patient-centered standards and reforms. However, there is more work left to do. The goal of these reports is to encourage states to implement a range of reforms in the key ares that will have the most benefit to patients.

Each progress report compares a state’s specific performance on all metrics within each of the five principles listed below and against other states’ performance on these same metrics:

  • Non-discrimination: Confirm plan designs do not discriminate or impede access to care, including a provider network that ensures patients can access care when they need it.
  • Transparency: Provide access to clear and accurate information for consumers about covered services and costs in exchange plans, including a user-friendly exchange website.
  • State oversight: Ensure all exchange plans meet applicable state and federal requirements, including the state's plan management and rate review.
  • Uniformity: Create standards to make it easier for patients to compare exchange plans, such as a quality scorecard and standardized plan materials.
  • Continuity of care: Broaden sources of coverage and protect patients transitioning between plans, including expanded Medicaid. 

For each principle, a state could receive one of three scores:

  • A state achieves a beneficial score when its policies or insurance market dynamics result in better access or choice for patients.
  • A state achieves a neutral score when it fails to have policies that result in better access or choice for patients.
  • A state achieves a negative score when its policies or insurance market dynamics result in reduced access or choice for patients.

Additionally, the progress report compares a state’s aggregate performance on all metrics within each principle to other states’ performance on these same metrics. This comparative assessment yielded groupings of high-performing states, average-performing states, and low-performing states for each principle.

A state’s performance as of January 1, 2015, informed the evaluation. Only policies that were in effect for the 2015 exchange market were included in these reports. 

The state progress reports are based on proprietary data maintained by Avalere Health. They were produced in groupings based on a list of states provided by the National Health Council. States with federally facilitated exchanges (FFE) that have not enacted laws to enhance to their insurance marketplace are assessed based on the federal exchange. Some FFE states received positive scores for adopting policies that go beyond the federal standards.

The NHC and its members are committed supporters of ACA provisions that provide the greatest benefit to people with chronic diseases and disabilities. Since the passage of the ACA, the NHC has worked to strengthen these protections so that patients can access health insurance that meets both their health and budget needs.


The NHC State Progress Report initiative is made possible with the generous support of Novartis Pharmaceuticals Corportation. Additional support was provided by AstraZeneca, Celgene, Genentech, and Johnson & Johnson.