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We are in a few states. One is Kentucky, a state based exchange, and the other states have conservative governors who opted to be part of the federal exchange. Even though states opt to be part of the federal exchange, the states are still responsible, in some cases, for day to day insurance activities (approval of forms, rates, etc). In the process of undergoing all of these changes and trying to make sense of all the new requirements between the federal and state exchanges, Kentucky has been excellent. The Kentucky Department of Insurance has helpful staff that answers the phone and gets back to us if we have questions or issues. The other departments of insurance in states with conservative governors have basically ignored our calls.
It's taken me no less than three weeks to get returned phone calls when I leave messages. No one outside of Kentucky has ever actually answered their phone directly. I've had to run the gamut all the way up as far as possible in the phone chain to get basic questions answered. Some states have created email addresses where questions can be submitted, but those have gone completely unanswered. The departments of insurance in those states were completely, and I mean COMPLETELY unprepared and the amount of time wasted running basic information to ground is colossal.
My personal belief is that they simply assumed the law would be overturned and did absolutely no basic groundwork. There was one point where insurers in one state had filings due, but didn't get the required information necessary to complete those filings out until 24 HOURS in advance of the due date. That deadline was simply impossible. The amount of actuarial work and legal drafting that goes into policies and rates makes that deadline literally impossible. It took us an additional three weeks and the insurance department accepted it. At this point, the ACA is starting to reap real dividends. One has to wonder how much better it could have been if there had been decent prep by the conservative states.