Most States Lack ACA Consumer Protection Laws, Survey Finds
Thirty-nine states have not enacted laws essential to enforcing new consumer protection rules under the Affordable Care Act, raising the possibility of increased federal oversight, according to a survey released Friday by the Commonwealth Fund, the Los Angeles Times reports (Levey, Los Angeles Times, 1/31).
Details of Consumer Protection Rules
The Affordable Care Act enacted a number of consumer protections, including:
- Banning insurers from discriminating against individuals with pre-existing medical conditions;
- Capping out-of-pocket consumer costs;
- Limiting waiting periods for new benefits to 90 days (Evans, Modern Healthcare, 2/1).;
- Prohibiting insurers from charging consumers more based on age, gender and health condition;
- Requiring insurers to accept every individual and employer that applies for coverage;
- Requiring insurers to cover 10 essential health benefits; and
- Requiring insurers to cover at least 60% of costs (Reuters, 2/1).
However, the survey -- which included responses from 40 states and the District of Columbia -- found that just eight states reported having existing authority to fully enforce the rules. Meanwhile, 22 said they have limited or no authority to guarantee the ACA's consumer protections (Modern Healthcare, 2/1).
Eleven states and the District of Columbia reported passing legislation addressing at least one of the consumer protections. Of those, Connecticut was the only state that reported passing legislation addressing all seven consumer protections, while California has addressed six of the protections with legislation (Reuters, 2/1).
States Could Cede Control of Insurance Regulation Unless They Act Quickly
If states fail to pass laws codifying the consumer protections, the federal government could step in, even though states typically regulate insurance markets (Los Angeles Times, 1/31).
The ACA requires federal officials to take over when states do not "substantially" enforce the law's seven new consumer protections (Modern Healthcare, 2/1).
Commonwealth Fund Vice President Sara Collins said, "Because insurance regulation falls to the states, states need to take action to make sure they can enforce the law and ensure their residents can fully benefit from it" (Reuters, 2/1).
The survey comes less than a year before the consumer protections are scheduled to take effect (Modern Healthcare, 2/1).Katie Keith -- lead author of the study -- said that if states want to maintain control over their insurance markets, they must act quickly. She added, "We expect the 2013 legislative session to be a critical time for state policymakers who wish to limit direct federal enforcement of the reforms" (Los Angeles Times, 1/31). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.