Only 11 states passed laws to enforce market reforms

As deadlines quickly approach for implementing certain provisions of the health reform law, many insurers still don't know who will actually enforce those provisions since only 11 states and the District of Columbia have passed laws or issued regulations, a new report from the Commonwealth Fund found.

Researchers from Georgetown University determined that 39 states have yet to act on seven core reform issues, including banning insurers from rejecting consumers with pre-existing medical conditions, limiting how much more insurers can charge older consumers, determining which specific essential health benefits insurers must provide, prohibiting insurers from enacting coverage waiting periods and maximizing out-of-pocket costs.

If states don't pass laws codifying these reform provisions within the next year, the federal government could step in and assume regulatory authority. "This means 2013 will be critical, with regulators telling us that enforcement could be limited if they don't have the legal authority," Katie Keith, an assistant research professor at Georgetown and co-author of the report, told Kaiser Health News.

The states that already enacted the provisions include: Arkansas, California, Connecticut, Maine, Maryland, New York, Oregon, Rhode Island, Utah, Vermont and Washington and the District of Columbia, the report noted.

Among those 11 states, though, only Connecticut has addressed all seven reform provisions. California has enacted laws for six provisions, while the remaining nine states have taken action on at least one provision, reported Reuters.

But despite the lackluster legislative action, the researchers clarified that insurers will still be subjected to some oversight and enforcement since all states review insurer filings for any federal and state law violations. And when state regulators find illegal actions, they either contact insurers directly to fix the problems or notify the federal government to seek penalties against insurers, KHN noted.

To learn more:
- here's the Commonwealth Fund report
- see the Reuters article
- check out the Kaiser Health News article

Suggested Articles

Absent adequate reimbursement for time spent on complex patient care, specialists are finding it harder to sustain their practices.

Tennessee released its proposal to CMS to become the first state to convert federal Medicaid funding into a block grant.

Hospital and health system leaders say a lack of data and confusion around reimbursement are barriers to risk-based payment agreements.