Nearly Half of States Implementing Health Reform



Two years after enactment of the Affordable Care Act, almost every state in the union has implemented at least one item from the law’s early market reforms, the Patient's Bill of Rights, an analysis from the Commonwealth Fund has found.

Of the 49 states that have taken some action, 23 (and the District of Columbia) passed legislation or enacted regulations addressing at least one of the reforms. Twelve states addressed all the reforms. An additional 15 issued guidance for insurers on the reforms, and 11 states took no action but reported that regulators were reviewing insurers’ policy forms for compliance with reforms.

Only Arizona has done nothing to enact ACA reforms

Early market reforms that comprise the Patient’s Bill of Rights include:

• Coverage for dependents until age 26 years.

• Coverage for children younger than age 19 years, regardless of preexisting conditions.

• Prohibition of lifetime limits on essential health benefits.

• Phasing out of annual limits on the cost of essential health benefits.

• Access to a gynecologist without a referral.

• Access to copayment-free preventive services.

• Prohibition of canceling insurance except in cases of fraud or intentional misrepresentation.

• Increased flexibility in choosing a pediatrician.

• Increased flexibility in choosing a primary care provider.

• Expanded coverage of emergency services.

The Commonwealth analysis did not examine state action on other insurance reforms, including medical loss ratio requirements or standards for insurance premiums.

Even as the Supreme Court readies to examine a host of legal challenges to the ACA, states seem to be supporting the law’s implementation, at least through their actions, according to Katie Keith, lead author of the analysis.

"The vast majority of states have been very busy on health reform, at least on these early market reforms," Ms. Keith said in an interview. "You can see [the reforms] being really baked into state law and regulatory practice in all 50 states."

As the law currently stands, if states don’t implement the Patient’s Bill of Rights by Jan. 1, 2014, the federal government will do it for them. States that have not acted on these ACA reforms already may have stronger patient protections or their laws already may allow enforcement of the ACA, Ms. Keith said.

But while the ACA brings unprecedented coverage, opponents say the costs outweigh the benefits.

"For individuals and employers, the results from these new federal regulations will be across-the-board increases in health insurance costs and premiums ... These additional costs will likely exceed any possible savings from lower administrative costs for insurers," according to a report from the Heritage Foundation.

The Obama administration contends that overall, reforms that create transparency in the market will result in lower costs.

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