Despite the sweeping federal changes included in the Patient Protection and Affordable Care Act, a new Commonwealth Fund study
notes that “states continue to be the primary regulators of health insurance” and they are implementing the federal laws at varying speeds—or, in the case of Arizona, not at all.
The Commonwealth Fund study looks at 10 “early market reforms,” collectively known as the Patient's Bill of Rights, which went into effect Sept. 23, 2010, and were designed to fill gaps in coverage such as banning lifetime or annual limits on benefits and retroactively cancelling coverage.
According to the report, 12 states passed legislation or issued regulations addressing all 10 provisions: Connecticut, Hawaii, Iowa, Maine, Maryland, Nebraska, New York, North Carolina, North Dakota, South Dakota, Vermont and Virginia.
The District of Columbia and 11 states passed a law or issued a regulation on at least one provision: California, Delaware, Indiana, Louisiana, Michigan, New Hampshire, New Jersey, Oregon, Utah, Washington and Wisconsin.
According to the report, some states have only acted when one of their existing laws was in direct conflict with the new federal law. As an example, they cited Indiana which only amended its existing laws on dependent coverage, rescissions and exclusions on pre-existing conditions among children to align them with the federal law.
Fifteen states issued “subregulatory guidance” to advise insurers of the reforms: Alabama, Arkansas, Colorado, Florida, Georgia, Illinois, Kentucky, Massachusetts, Minnesota, Missouri, Montana, New Mexico, Pennsylvania, South Carolina and Texas.
Eleven states had not done any of these things, but reported that regulators were reviewing insurer filings for compliance with the reforms: Alaska, Idaho, Kansas, Mississippi, Nevada, Ohio, Oklahoma, Rhode Island, Tennessee, West Virginia and Wyoming.
According to the report, “State regulators have reported that subregulatory guidance or review of policy forms appears to have been effective in promoting compliance with the reforms.”
Only one state, Arizona, has taken no official action, though the report notes that, while reviewing insurer policy forms for compliance with state law they have “flagged those not in compliance” with federal law and when the state department of insurance informally notified insurers “they corrected all the violations.”