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TheStatebyStateImpactofACARegulationsSamBatkinslOctober2012SincepassageoftheAffordableCareAct(ACA),theAmericanActionForum(AAF)hastrackedthestateofits

regulatoryimplementation.Todate,theACAhasimposedatotalof$27.6billioninnewregulationsatleast

$20.4billioninlifetimecostsonprivateentitiesand$7.2billioninincreasedburdensonstatebudgets.Inthis

paperAAFexamineshowthis$27.6billioninnewcostsbreakdownonastate-by-statelevel.Thedatashow

thatfivestateswillendureatleast$1billioninACAregulatorycosts.

Methodology

AAFexaminedthetenmostexpensiveACAregulations(seeFigure1).Todate,thereare85newrulemakings

asaresultofthislaw.Thetoptenmostexpensiveregulationsaccountfor88percentofthetotalregulatory

costsatotalof$24.4billion.Ineachnon-Medicaidregulation,federalagencieslistedtheregulatedindustries.AgencieswilltypicallyprovideaNorthAmericanIndustryClassificationSystem(NAICS)codefor

eachaffectedindustry.AAFreferencedtheseNAICSCensuscodesandexaminedthegeographicdistribution.

Thus,AAFisabletobroadlydeterminethestate-by-stateimpactofeachregulation.Finally,forMedicaid

regulations,AAFsimplyapportionedcostsbythepercentageofMedicaidrecipientsineachstate,which

correlatessomewhattopopulation,butnotprecisely.

Figure1:TenMostExpensiveACARegulations

Regulation TotalCost

PaperworkBurden

Hours EntitiesAffected

OperatingRules $5.9Billion 0 PrivateCommunityFirstChoiceOption $5.7Billion 0 State

EstablishmentofExchanges $3.4Billion 1.1Million Private

RulesforHealthCareElectronicFunds

Transfers$3.3Billion 140,772 Private

AdoptionofaStandardHealthPlan $2Billion 60,300 Private

Medicare,Medicaid,CHIP;

Transparency$1.7Billion 8Million Private

MenuLabeling $757Million 2.6Million Private

MedicaidProgramEligibilityChanges $580Million 21.2Million State

MedicaidProgramandCommunity

BasedServices$580Million 489 State

GroupHealthPlansandInsurance

Issuers$275Million 2.7Million State

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regulatorycosts.PreviousAAFresearchhasshownthatmanyoftheACAscostswillremainafter2012,andits

implementationhashardlybeentransparent.

Figure3:State-by-StateRegulatoryImpactsoftheACA

State ACARegulatoryCosts LostEmployment

Alabama $346Million 270

Alaska $52Million 37

Arizona $567Million 461

Arkansas $249Million 201

California $3.4Billion 2,917

Colorado $372Million 223

Connecticut $285Million 202

Delaware $77Million 59

DistrictofColumbia $56Million 45

Florida $1.6Billion 978

Georgia $722Million 556

Hawaii $105Million 73

Idaho $119Million 76

Illinois $1Billion 816

Indiana $464Million 347

Iowa $230Million 163

Kansas $204Million 113

Kentucky $338Million 251

Louisiana $413Million 333

Maine $119Million 97

Maryland $434Million 269

Massachusetts $521Million 431

Michigan $794Million 580

Minnesota $354Million 268

Mississippi $224Million 197

Missouri $461Million 321

Montana $79Million 49

Nebraska $144Million 87

Nevada $175Million 92

NewHampshire $82Million 54

NewJersey $681Million 376

NewMexico $168Million 153

NewYork $1.7Billion 1,383

NorthCarolina $666Million 537

NorthDakota $46Million 24

Ohio $896Million 661

Oklahoma $324Million 227Oregon $294Million 200

Pennsylvania $957Million 648

RhodeIsland $91Million 64

SouthCarolina $319Million 256

SouthDakota $64Million 39

Tennessee $505Million 406

Texas $1.8Billion 1,292

Utah $178Million 104

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Vermont $61Million 53

Virginia $499Million 313

Washington $462Million 347

WestVirginia $151Million 107

Wisconsin $397Million 308

Wyoming $42Million 33

Totals $24.4Billion 18,098