States’ Implementation of ACA Varies, Commonwealth Fund Finds
However, the majority of states have implemented or taken legislative or regulatory action to roll out at least one of the two ACA provisions, researchers from Georgetown University and the Trimpa Group noted (Demko, "Vital Signs," Modern Healthcare, 1/31).
According to the report:
- 32 states and Washington, D.C., have adopted new legislation or regulations to implement at least one of the insurance market reforms mandated under the law, such as the ban on denials of coverage to applicants with preexisting conditions or providing a minimum number of essential health benefits;
- 26 states and D.C. have expanded or are taking action to expand Medicaid;
- 16 states and D.C. have established their own health insurance exchanges; and
- 10 states -- California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, New York, Oregon and Vermont -- have done all three of the above actions (Commonwealth Fund release, 1/31).
Meanwhile, five states -- Alabama, Missouri, Oklahoma, Texas and Wyoming -- have refused to implement any of the law's provisions. They are using the federal government-operated health insurance exchange, have declined to expand their Medicaid programs and have decided not to enforce any of the law's insurance reforms ("Vital Signs," Modern Healthcare, 1/31).
The report also found that most states are shouldering some responsibility in enforcing the implementation of the ACA's health insurance reforms. Specifically:
- 25 states and D.C. will directly enforce insurance market reforms using their existing legal authority or because they have adopted some of the ACA's reforms;
- 17 states enacted legislation requiring or permitting state regulators to enforce at least some of the law's insurance reforms; and
- Three states have adopted a federal-state collaborative approach, under which the states will monitor for compliance and the federal government will enforce the requirements (Commonwealth Fund release, 1/31).
Co-author Kevin Lucia, a research professor at Georgetown, said more states might be willing to enforce the market reforms because they generally are more comfortable with that aspect of policy. He added. "This is something that traditionally the states have always done. They have always played this enforcement role" ("Vital Signs," Modern Healthcare, 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.