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Map showing states that have and have not passed new laws or regulations to comply with the Affordable Care Act as of January, 2013.

The Obama administration might be having to take on more than anticipated when the new health insurance regulations included in the Affordable Care Act kick in in 2014. An outgrowth of the protracted legal battle over the law was that states delayed doing much of the work that's required, while they waited to see if the law would stand. That has resulted, the Commonwealth Fund finds, in the majority of states being unprepared to enforce the new insurance regulations, like ending pre-existing conditions.

The enforcement of the new regulations was intended to fall to the states. The analysis shows that only one state—Connecticut—has passed new legislation to enforce all of these new protections, and another 10 (Arkansas, California, Maine, Maryland, New York, Oregon, Rhode Island, Utah, Vermont and Washington along with the District of Columbia) have passed new legislation or issued a new regulation to cover at least one protection. That leaves 39 states lagging.

States have to act this legislative session to get these new laws and regulations in place, or cede that regulation to the feds.

“We don’t know what capacity the federal government has to enforce these protections,” Georgetown’s Kevin Lucia, a co-author of the study, says. “One way or another this will be the law of the land. It’s really a question of are the states going to do the enforcement, and maintain their traditional role, or will the federal government need to step in.” [...]

If a state does not have authority to enforce the Affordable Care Act, that doesn’t mean it becomes null and void: Rather, the enforcement authorities then fall to the federal government.

“It’s a question of both capacity and complexity, whether they have an appreciation for the nuances of each state market,” lead study author Katie Keith, also at Georgetown, says.

This wouldn't be unprecedented; the federal government had to pick up the regulatory enforcement slack for the 1996 Health Insurance Portability and Accountability Act in five states. It's not a terribly onerous burden for the federal government, but not one they intended to have to take on.

And if Republican legislatures and governors are thinking about dragging their heels to try to undermine the law, they might want to think twice. These are the extremely popular consumer protections, the parts of the law that says insurance companies can no longer arbitrarily deny people coverage, or charge them outrageous premiums for the flimsiest of reasons. That's not the stuff to be taking political stands over.

Originally posted to Joan McCarter on Fri Feb 01, 2013 at 08:24 AM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (19+ / 0-)

    "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

    by Joan McCarter on Fri Feb 01, 2013 at 08:24:57 AM PST

  •  Living in Oklahoma (14+ / 0-)

    I think I would prefer to have the federal government enforce these regulations.

    We have a state insurance commissioner who, in my opinion, is simply a lobbyist for the insurance companies. He doesn't give a damn about consumers.

  •  A comment on the current system (6+ / 0-)

    I lost my insurance for almost two years when I was laid off from my former employer. I finally landed a job and got my coverage back. On my first visit to the doctor my claim was denied as a preexisting condition.

    So now I essentially still don't have coverage unless I am fortunate enough to develop a new medical problem.

    Is this a great system or what?

    •  Wait...there's supposed to not be pre-existing (1+ / 0-)
      Recommended by:

      conditions anymore due to ACA, right? Might want to double check that claim with your insurer.

      When life gives you wingnuts, make wingnut butter!

      by antirove on Fri Feb 01, 2013 at 05:08:50 PM PST

      [ Parent ]

      •  Blue Cross told a friend of mine not to count on (2+ / 0-)
        Recommended by:
        antirove, musiccitymollie

        the pre existing exclusion going away.  I was shocked but some insurance companies are telling their customers that they are not sure that is going to be enforced. Then I have friends who tell them their insurance companies are telling them that their rates will go up if they cannot refuse people due to pre existing conditions. Ie some insurance companies are lying to patients, misleading them , and so on. Be on the lookout for that. I was stunned because my insurance company tends to like and promote ACA but some do not and some insist they are not sure when they will decide to make changes.

        Follow PA Keystone Liberals on Twitter: @KeystoneLibs

        by wishingwell on Fri Feb 01, 2013 at 05:29:41 PM PST

        [ Parent ]

      •  It did go away but they can charge you so much (1+ / 0-)
        Recommended by:

        that you can't afford it.

        •  Although you will... (0+ / 0-)

          ...get a rebate if they don't spend enough of the premiums on medical care.

          It's unknown how many chronically ill people who are now living w/o insurance due to pre-existing conditions will choose to get insurance once they are no longer excluded and can't be charged extraordinary high rates reflecting their higher risk status. Estimates on such things are likely to be quite wrong for a variety of reasons.

          These patients may be very expensive to provide care for. One of the nightmare scenarios for an insurance company may be someone who requires 7/24 skilled nursing care for a condition and who is currently relying on government provided care but is unhappy with the choices and level of care. If such a person has middle class parents, they could now pay for an insurance policy for their offspring (since such a person is unlikely to be making a living). It could take the profit from thousands of "moderate risk" insureds to just to provide health care for this one person - i.e., just to break even. Although there are probably not many such people, they are extraordinary risks.

          Once the insurance company has written a policy w/a specific rate, I think they are generally required to honor that rate for the term. If they underestimate the rate, they don't have the luxury of going back to the rate payers to get a rebate if they spent 110% of premiums on health care (unlike the rate payers who do get a rebate if the insurance company guesses too high on the premiums). I expect insurance companies to be conservative and jack rates up quite high and adjust them down slowly as needed once they have data to know where to set rates.

          I also expect some, perhaps most, insurers to just suspend writing new individual policies entirely while this all sorts out. Once a few large insurers do this, there could be a domino effect as those insurers who are writing new policies end up with more high risk patients so they can't be cost competitive and attract any of those already insured with companies no longer writing new policies.

          It should be interesting to watch. I'm very glad I have access to a self-insured employer plan which won't be impacted much by the PPACA.

          •  Are you sure that . . . (0+ / 0-)

            ". . . a self-insured employer plan which won't be impacted much by the PPACA."

            I'm not contesting your statement, but it does contradict what Mr. Mollie's "self-insured employer" is telling us.

            We were told during last year's "Open Enrollment" for  their group plan, that they would not likely offer group insurance if the (PP)ACA was not repealed.  They cite the adverse impact of the bill.

            Final word has not come down.  We just hope that it does before the traditional Open Enrollment period, which is the month of November.

            Are they lying?  (BTW, we wouldn't be surprised if they are, LOL!)


            "Only he who can see the invisible, can do the impossible." --Frank L. Gaines

            "If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

            by musiccitymollie on Sat Feb 02, 2013 at 10:35:38 AM PST

            [ Parent ]

    •  hnichols--You might want to check this American (0+ / 0-)

      Cancer Society brochure, or brief on "How the ACA affects pre-exisiting conditions and HIPAA."

      Good luck!


      "Only he who can see the invisible, can do the impossible." --Frank L. Gaines

      "If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

      by musiccitymollie on Sat Feb 02, 2013 at 10:28:41 AM PST

      [ Parent ]

  •  Well, to be fair, in IL they're very very busy (5+ / 0-)

    trying to screw over teachers and everyone else the Lege already screwed over by refusing to pay into the pension fund for at least 30 years now. So they can't do anything about health care.

    •  Same in Kentucky. (1+ / 0-)
      Recommended by:

      There's a horrible shortfall because of the underfunded pensions. But at least Ky's not fighting the healthcare law, and says it will implement it.

    •  yes as here in PA, they are too busy privatizing (1+ / 0-)
      Recommended by:
      astrogeology girl

      everything, bragging about having more casinos and gambling than any state other than Nevada, and trying to make PA into a Right to Work state ..and oh yes, changing how electoral votes are awarded. They are too busy engaging in teabauchery.  I saw the governors press conference and threw up in my mouth.  

      Follow PA Keystone Liberals on Twitter: @KeystoneLibs

      by wishingwell on Fri Feb 01, 2013 at 05:31:57 PM PST

      [ Parent ]

    •  I apologize in advance but I cannot resist (0+ / 0-)

      Hitler was able to screw over the unions, establish a dictatorship, conquer the neighboring countries and threaten to bring the entire world under subjugation.  What are those legislators in IL doing?  How much time do they think they will need?
      (again, sorry but I could not resist)  

  •  I believe MN already implemented (0+ / 0-)

    many health reforms over the last decade that already put it ahead of most states; whatever remaining laws need to be passed will likely be taken care of this year as the DFL now controls the legislature.

  •  Why are the states fighting this so hard? (1+ / 0-)
    Recommended by:
    •  The Rupublicans are fighting hard to stop Obama (2+ / 0-)

      from being a three term president.

    •  Republican governors , legislatures all because it (2+ / 0-)
      Recommended by:
      blukat, Ishmaelbychoice

      is Obamacare. They intend to fight anything he does even if people are hurt badly or die because of their teabagging ways.

      Follow PA Keystone Liberals on Twitter: @KeystoneLibs

      by wishingwell on Fri Feb 01, 2013 at 05:33:13 PM PST

      [ Parent ]

    •  because this is the largest innovation since (2+ / 0-)

      the New Deal and the Great Society.  They cannot allow an African American to succeed

      •  And it never even... (0+ / 0-)

        ...crossed your mind that some people just don't think the policy is good policy?

        Assuming that anyone who doesn't agree with a policy supported by President Obama is because that person "cannot allow an African American to succeed" is very short sighted. Indeed, this calls for a quote attributed to Mayor Koch:

        If you agree with me on nine out of 12 issues, you should vote for me. If you agree with me on 12 out of 12 issues, you should see a psychiatrist.
        It makes as much sense as saying that the reason people opposed the Iraq war early on was because they couldn't let a Republican president succeed.

        Fail to bother to understand the opposition's actual policy based reasons for opposing something at your own peril.

        •  short sighted voters? (0+ / 0-)

          May I point to the second term of GWB?

        •  except there is evidence to the contrary (0+ / 0-)

          policies being supported without being associated with Mr. Obama, and then being opposed by those same individuals, both in polling and in Congress, when they find out he's in favor of it or (gasp!) proposes it.

          How is taking a hundred dollars worth of food from hungry kids or from old poor sick people equal to taking a hundred dollars from billionaires? -- howabout, 19 Dec 2012

          by billlaurelMD on Sat Feb 02, 2013 at 07:22:57 AM PST

          [ Parent ]

    •  Right-wing ideology, and in my state-- (0+ / 0-)

      barebones state budgets.

      Remember, that are several states that don't even have a state income tax.  (Just exorbitant, regressive state and local sales taxes.)

      Aside from ideology, these states will undoubtedly find it more difficult to fund Medicaid, much less an expanded version.  Yet, they still won't consider implementing a progressive state income tax.  

      This is one of the weaknesses of the ACA.  (Which is not the same as saying that the ACA is worthless.  Objectively, it does have some flaws, or glitches, that need work.  That's all.)

      Folks are too much at the mercy of their state government.  Especially difficult on those of us who are in "red" states.


      "Only he who can see the invisible, can do the impossible." --Frank L. Gaines

      "If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

      by musiccitymollie on Sat Feb 02, 2013 at 10:44:24 AM PST

      [ Parent ]

  •  Lovely to live in (1+ / 0-)
    Recommended by:

    Connecticut -- for some reason.  It helps to have a Democratic legislature and Governor and even some sane Republicans.

    " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

    by gchaucer2 on Fri Feb 01, 2013 at 05:14:59 PM PST

  •  Bypass the States, and Insurance companies.... (4+ / 0-)

    ....Pass Medicare for All. True Universal, single payer.

  •  I am in SC and they intend to do nothing (0+ / 0-)

    They are going to force the feds to either take them to court to force them or else. if the feds do assume control, to then sue the feds for interfering in state affairs.

    It sounds like a nonstarter since the ACA has been hashed out by SCOTUS to some degree but you have to remember in the past 2 years, SC has almost passed bills outlawing federal script, returning the state to the gold standard and instructing the state to issue its own currency. (and I thought all of this had been hashed out by 1800)

  •  texas (5+ / 0-)

    so my gov is "Fed Up" with this "vicious power grab" from Obama, so much so that he abdicates all state duty and forces the Fed to manage our half-ass governed state? Shocking!

    Wait, not shocking at all. Sigh.

    If only Michael Phelps hadn't smoked that pot...imagine what he could have accomplished with motivation and good lung capacity.

    by papa monzano on Fri Feb 01, 2013 at 05:32:54 PM PST

  •  Glad I am in Oregon (0+ / 0-)

    Who started to get in the game back in 2011. Seems things are going okay so far (I'm sure there are kinks but better having them ironed out ahead of time).

    Strange other states aren't trying to find out what is working for Oregon. Guess some don't want to be seen working with a blue state?

  •  Bring on the feds. Languishing in Alaska. (1+ / 0-)
    Recommended by:
  •  First they waited for Scotus, then the election (0+ / 0-)

    results, which i guess was reasonable, now they have no excuses left.

  •  What are the nuances? How are the health care (0+ / 0-)

    issues of people in one state different than those in another? I understand that one state might have a higher rate of obesity, or teen pregnancy, or black lung disease. But beyond that, even including the above, we are just talking about human health that does not vary in accordance with state lines.

    The state by state construct was a bone tossed to bring Republicans on board. If they don't like it, why have any hesitance to chuck it and set up the Federal exchange?

    I'm not asking rhetorically. There must be some reason that I am just unable to fathom.

    •  Health Care... (0+ / 0-)

      ...costs and expectations also vary dramatically from region to region. But, I don't think this complicates the problem for the Feds. Private insurers understand these things and deal with them today and they will set rates to whatever levels are necessary (assuming they are willing to write new policies after 1/1/2014).

      Enforcing the PPACA seems fairly straight forward and I also don't see how it's "state dependent" -- although, obviously, more Federal level instead of state level personnel will be required for the enforcement if the Feds have to do the enforcement.

      •  "State dependent" may refer to the fact that (0+ / 0-)

        states are granted "waivers" pretty liberally.  I'm in a state that several years ago pretty much eviscerated (under a DLC Dem, I might add) the Medicaid program.

        Get this, the state legislature took a vote on limiting the skimpy "managed care" privatized Medicaid coverage to $12,000 per beneficiary, per year.  [It was a "managed care" program.]  

        The first attempt failed.  Honestly, didn't continue to follow the issue, so I have no idea if they were successful in this endeavor, or not.

        I sure hope they weren't.

        Heck, it would cost $12,000 to get treatment if you 'stumped your toe good,' LOL!

        Anyhoo, "waivers" are what allowed the drastic cuts in benefits for Medicaid beneficiaries.


        "Only he who can see the invisible, can do the impossible." --Frank L. Gaines

        "If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

        by musiccitymollie on Sat Feb 02, 2013 at 10:53:37 AM PST

        [ Parent ]

  •  38 States... (0+ / 0-)

    ... Massachusetts didn't need new legislation; it was already there in Romneycare.

  •  Oregon Web site is up (0+ / 0-)

    Check out advance preparations already moving ahead in Oregon.

    The Web site gives a taste of the benefits for individual residents:Cover Oregon

    "Archaeological description is . . . an abandonment of the history of ideas, a systematic rejection of its postulates and procedures, an attempt to practice a quite different history of what men have said." --Michel Foucault

    by Adelard of Bath on Sat Feb 02, 2013 at 06:28:35 AM PST

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