Implementing the Affordable Care Act: State Action on the 2014 Market Reforms

February 1, 2013 | Volume 8

Authors: Katie Keith, Kevin W. Lucia, and Sabrina Corlette
Contact: Katie Keith, J.D., M.P.H., Assistant Research Professor, Center on Health Insurance Reforms, Georgetown University Health Policy Institute, kmk82@georgetown.edu
Editor: Deborah Lorber

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State Action on Health Insurance Premiums

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Overview

The Affordable Care Act includes numerous consumer protections designed to improve the accessibility, adequacy, and affordability of private health insurance. Because states are the primary regulators of health insurance, this issue brief examines new state action on a subset of protections—such as guaranteed access to coverage and a ban on preexisting condition exclusions—that go into effect in 2014. The analysis finds that, to date, only one state passed new legislation on all of these protections, and an additional 10 states and the District of Columbia passed new legislation or issued a new regulation on at least one protection. The analysis also finds that—without new legislation—some states face limitations in fully enforcing these reforms. These findings suggest an acute need for states to take action in 2013 to help ensure that consumers are fully protected by and benefit from the Affordable Care Act’s most significant reforms.

Citation

K. Keith, K. W. Lucia, and S. Corlette, Implementing the Affordable Care Act: State Action on the 2014 Market Reforms, The Commonwealth Fund, February 2013.

Post a Comment / View All Comments (3)

Featured Comment:

Katie Keith, of Georgetown University Health Policy Inst (February 04, 2013):

These are both great comments and thank you for your feedback! John - you're exactly right that consumers get the same protections from federal regulation and you pose a great question about the incentives for state enforcement of these reforms. We were interested in the same question and heard consistently from state insurance regulators that they want to limit direct federal enforcement in their state because 1) they have long-standing experience in regulating their insurance markets, 2) they know the key players and appreciate the complexity of their markets, and 3) they feel they are in the best position possible to respond to consumer complaints. The experience with implementation of the Health Insurance Portability and Accountability Act (which uses a similar framework to the ACA) is consistent with this idea and shows that nearly all states eventually passed new laws or issued new regulations implementing the federal requirements. Randall - thank you for your comments and suggestion about population data! This is a great idea and something we will certainly consider in our future reports. Beyond the state's total population, perhaps we will look to how many people are in the individual and small group markets in those states. Thank you for this idea! While it is certainly true that five states implemented guaranteed issue prior to the ACA, we limited our analysis to new state action, in part, because even states with existing laws that are similar to the ACA may not fully conform to the ACA's requirements. For example, states with guaranteed issue may still need to amend their requirements regarding open and special enrollment periods or align these periods with the exchange. Another example is in the coverage of young adults: while some states allow dependents to enroll even above age 26, these laws often have restrictions that the ACA does not have (i.e., the young adult must be a full-time student, unmarried, etc.). With many state standards that are similar to the ACA, we felt that determining whether existing state law complies with the ACA should be left to the state and federal governments and instead focused on new state action specific to the ACA. I hope that helps explain our approach and am happy to discuss further, if helpful. Thanks again!