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

1. Implementing the Affordable Care Act: State Action on the 2014 Market Reforms The Commonwealth Fund March 12, 2013 Kevin Lucia, JD, MHP Katie Keith, JD, MPH

2. CHIR’s Monitoring and Analysis of Health Reform • Document state action on the Affordable Care Act in all 50 states and DC, including: • Health insurance market reforms • Health insurance exchanges; and • Other regulatory changes to ensure a level playing field. • Comprehensive data collection and real-time analysis of legislation, regulations, and other state materials. • Project generously supported by the Commonwealth Fund.

3. Regulating Health Insurance: Cooperative Federalism • States are and continue to be the primary regulators of health insurance for consumers in the individual and small group markets. • Congress adopted a cooperative approach for regulating health insurance when it passed HIPAA in 1996 for shared regulation between the federal government and the states. • When does the federal government enforce? • State reports that it is not enforcing. • HHS determination that state has failed to “substantially enforce.” • Most stakeholders want the states to implement and enforce the Affordable Care Act.

4. The Affordable Care Act • Signed March 23, 2010 by President Obama • Implemented in phases:

5. State Action on 2014 Market Reforms • Issue brief released in February 2013 and available – with interactive map – on Commonwealth Fund website. • Reviewed state legislation, regulations, sub-regulatory guidance on seven of the Affordable Care Act’s most significant consumer protections: • Surveyed state regulators to assess whether the state has full authority to enforce the 2014 market reforms without new legislation. • Guaranteed issue • Waiting periods • Rating requirements • Preexisting condition exclusions • Essential health benefits • Out-of-pocket costs • Actuarial value

6. State Action on 2014 Market Reforms • State progress in implementing the 2014 market reforms: • 11 states and DC passed new legislation on at least one of the seven protections. • Only Connecticut addressed all seven protections. • 39 states have yet to take action on the seven protections. • State ability to enforce the 2014 market reforms: • 11 states passed new legislation to enforce the Affordable Care Act. • Of the remaining states, at least 22 reported limits on their ability to enforce without new legislation.

7. State Progress in Implementation

8. Future Expectations for State Implementation of Market Reforms • Most states still have a long way to go but many plan to introduce legislation in 2013. • States will continue to vary in their approach – including the type of state action they use. • State regulators may be creative in implementing the law using existing authority to implement or enforce these reforms. • There is a continued need for ongoing monitoring and analysis of state implementation of the Affordable Care Act.

9. Thank you! Kevin Lucia, JD, MHPResearch Professor and Project Directorkwl@georgetown.edu 202-687-4928 Katie Keith, JD, MPH Assistant Research Professor kmk82@georgetown.edu 202-687-4954