Most states making healthcare reform headway
Forty-nine states and Washington, D.C., already have taken action supporting the Patient Protection and Affordable Care Act’s (PPACA) implementation, such as passing legislation, issuing regulations or other guidance, or actively reviewing insurer filings, according to an issue brief from Commonwealth Fund.
The report, “Implementing the Affordable Care Act: State Action on Early Market Reforms,” assesses state action on 10 early reforms, including those known collectively as the Patients' Bill of Rights, that went into effect in September 2010. The researchers found that between January 1, 2010, and January 1, 2012, 23 states and Washington, D.C., had taken new legislative or regulatory action on at least one of these reforms, and an additional 26 states had taken other action to promote compliance with the reforms, such as issuing bulletins to insurers.
The reforms in the study include:
According to the authors, states had a relatively short turnaround time to implement the early market reforms. The legislation was signed into law on March 23, 2010, and implementation of the early market reforms went into effect just six months later. The mixed approaches to implementing the reforms may also have been a result of timing issues, including such factors as: reforms going into effect after most state legislatures had adjourned for 2010; short 2011 legislative sessions; changes in the state's political environment following mid-term elections; and state budget crises. Others may have been cautious given the pending decision on the constitutionality of the law by the U.S. Supreme Court.
States have a much longer lead time going into implementation for the 2014 reforms, the report noted yet cautioned that states may need to be more aggressive in their approaches with these reforms given that many are entirely new and do not exist in state law.
"Unlike the early market reforms, many of the 2014 reforms—such as a ban on denying insurance coverage based on preexisting conditions and new rating requirements—do not exist in state law. State standards may also be inconsistent with these reforms more often than with the early market reforms. Addressing these gaps will likely require states to make legislative or regulatory changes," the authors wrote.
Thus, to implement the 2014 reforms, states will likely have to go above and beyond the approach of reviewing insurer filings for compliance with the early reforms that some have taken, they concluded. “This is, in part, because states that only review insurer filings may be limited in their ability to hold insurers accountable to the new rules.”
The report, “Implementing the Affordable Care Act: State Action on Early Market Reforms,” assesses state action on 10 early reforms, including those known collectively as the Patients' Bill of Rights, that went into effect in September 2010. The researchers found that between January 1, 2010, and January 1, 2012, 23 states and Washington, D.C., had taken new legislative or regulatory action on at least one of these reforms, and an additional 26 states had taken other action to promote compliance with the reforms, such as issuing bulletins to insurers.
The reforms in the study include:
- Expanding dependent coverage for young adults up to age 26;
- Prohibiting lifetime limits on health benefits;
- Phasing out annual dollar limits on health benefits;
- Prohibiting pre-existing condition exclusions for children under age 19;
- Prohibiting rescissions (cancelling insurance, except in cases of fraud or intentional misrepresentation);
- Covering preventive services without cost-sharing;
- Expanding coverage of emergency services;
- Allowing choice of primary care provider;
- Allowing choice of pediatrician; and
- Allowing access to obstetricians and gynecologists without a referral.
- Twelve states—Connecticut, Hawaii, Iowa, Maine, Maryland, Nebraska, New York, North Carolina, North Dakota, South Dakota, Vermont and Virginia—passed new legislation or issued new regulations that addressed all 10 of the reforms.
- Washington, D.C., and 11 states—California, Delaware, Indiana, Louisiana, Michigan, New Hampshire, New Jersey, Oregon, Utah, Washington and Wisconsin—passed a new law or issued a new regulation on at least one early market reform.
- Fifteen states—Alabama, Arkansas, Colorado, Florida, Georgia, Illinois, Kentucky, Massachusetts, Minnesota, Missouri, Montana, New Mexico, Pennsylvania, South Carolina and Texas—issued new subregulatory guidance, such as a bulletin to advise insurers of the reforms.
- Eleven states—Alaska, Idaho, Kansas, Mississippi, Nevada, Ohio, Oklahoma, Rhode Island, Tennessee, West Virginia and Wyoming—reported that regulators were actively reviewing insurer filings for compliance with the reforms even though the state had not otherwise passed a new law or issued new regulations or other guidance.
- Only Arizona had taken no action.
According to the authors, states had a relatively short turnaround time to implement the early market reforms. The legislation was signed into law on March 23, 2010, and implementation of the early market reforms went into effect just six months later. The mixed approaches to implementing the reforms may also have been a result of timing issues, including such factors as: reforms going into effect after most state legislatures had adjourned for 2010; short 2011 legislative sessions; changes in the state's political environment following mid-term elections; and state budget crises. Others may have been cautious given the pending decision on the constitutionality of the law by the U.S. Supreme Court.
States have a much longer lead time going into implementation for the 2014 reforms, the report noted yet cautioned that states may need to be more aggressive in their approaches with these reforms given that many are entirely new and do not exist in state law.
"Unlike the early market reforms, many of the 2014 reforms—such as a ban on denying insurance coverage based on preexisting conditions and new rating requirements—do not exist in state law. State standards may also be inconsistent with these reforms more often than with the early market reforms. Addressing these gaps will likely require states to make legislative or regulatory changes," the authors wrote.
Thus, to implement the 2014 reforms, states will likely have to go above and beyond the approach of reviewing insurer filings for compliance with the early reforms that some have taken, they concluded. “This is, in part, because states that only review insurer filings may be limited in their ability to hold insurers accountable to the new rules.”