When a child turns two, it’s natural to take stock of all
the milestones they have achieved such as first steps, first words and first
solid foods. Some parents are even
organized enough to document all these achievements in a baby book. As the Affordable Care Act turns two,
we have a scrapbook of sorts to share with you on all that the ACA has achieved
in its 24 months of existence.
Just as it takes a village to raise a child, it took
three of us here at the Georgetown Health Policy Institute (Katie Keith,
Sabrina Corlette and Kevin Lucia) along with the generous support and guidance
from the Commonwealth Fund to produce our report.
We found that 49 states and the District of Columbia have
already taken their “first steps” supporting the law’s implementation, such as
passing legislation, issuing regulations or other guidance, or actively
reviewing insurer filings. Early insurance market reforms in the law, including
new rules for insurers such as bans on lifetime limits on benefits and
dependent coverage for young adults up to age 26, are already hard at work
Our report is the first to assess state action on 10
early reforms, including those known collectively as the Patients’ Bill of
Rights, which went into effect in September 2010. We found that 23 states and
the District of Columbia had taken new legislative or regulatory action on at
least one of these reforms, and an additional 26 states had taken other action
to promote compliance with the reforms, such as issuing bulletins to insurers.
The reforms in the study include:
* expanding dependent coverage for young adults up to age
* prohibiting lifetime limits on health benefits,
* phasing out annual dollar limits on health benefits,
* prohibiting preexisting condition exclusions for
children under age 19,
* prohibiting rescissions (cancelling insurance, except
in cases of fraud or intentional misrepresentation),
* covering preventive services without cost-sharing,
* expanding coverage of emergency services,
* allowing choice of primary care provider,
* allowing choice of pediatrician, and
* allowing access to obstetricians and gynecologists
without a referral.
Here are some other important milestones that have been
* Twelve states–Connecticut, Hawaii, Iowa, Maine,
Maryland, Nebraska, New York, North Carolina, North Dakota, South Dakota,
Vermont, and Virginia–passed new legislation or issued new regulations that
addressed all 10 of the reforms.
* The District of Columbia and 11 states–California,
Delaware, Indiana, Louisiana, Michigan, New Hampshire, New Jersey, Oregon,
Utah, Washington, and Wisconsin–passed a new law or issued a new regulation on
at least one early market reform.
* Fifteen states–Alabama, Arkansas, Colorado, Florida,
Georgia, Illinois, Kentucky, Massachusetts, Minnesota, Missouri, Montana, New
Mexico, Pennsylvania, South Carolina, and Texas–issued new subregulatory
guidance, such as a bulletin to advise insurers of the reforms.
* Eleven states–Alaska, Idaho, Kansas, Mississippi,
Nevada, Ohio, Oklahoma, Rhode Island, Tennessee, West Virginia, and
Wyoming–reported that regulators were actively reviewing insurer filings for
compliance with the reforms even though the state had not otherwise passed a
new law or issued new regulations or other guidance.
* Only Arizona had taken no official state action.
These findings show not only that the vast majority of
states have taken action on the early market reforms but that states have
adopted a range of pragmatic approaches to help ensure that their residents
receive the full benefits of the consumer protections promised under the
Affordable Care Act.
The ACA is young and there are many great years ahead. As
states implement the provisions scheduled for 2014, they will have to be more
proactive in their approach given that unlike the early market reforms, many of
the new reforms are entirely new and do not exist in state law.