The success of health care reform will be determined by the states that implement it, and so far sate officials have done an impressive job of ignoring the repeal calls of state politicians and laying the groundwork for effective implementation. According to the National Governor’s Association (NGA), 19 states have “created some body to work on implementation” — even as 5 of those states (Virginia, Pennsylvania, Nevada, Minnesota, Michigan) are suing the federal government over the constitutionality of reform. (Read the progress they’ve made here)
Almost all the states seem capable of implementing the measure, a National Association of Insurance Commissioners (NAIC) survey of state officials found. In a letter to HHS Secretary Kathleen Sebelius the group reported that “almost half of the states have concluded that they have the ability to enforce the federal law either through explicit state laws or general powers granted to the commissioner”:
In addition, almost all states can use their form approval process, investigative powers, and/or market conduct exam authority to hold licensed insurers accountable for their compliance with the federal laws. This, combined with coordinated enforcement by the federal regulators, should be sufficient to ensure carriers comply with the new requirements.
Implementation is of course ongoing. At least 20 states have begun processing applications for high risk insurance pools and many have already adopted the law’s most popular consumer protections. Connecticut, for instance has just passed a law requiring insurers to provide dependent coverage “to full-time students living in or out of state, or those under 26 living in Connecticut who do not have their own employer-sponsored health insurance plan.”
The real test for states will be how well they’ll do in withstanding insurer pressure against enforcing the new consumer protections and if they’re ready to establish the exchanges in 2014. Politico’s Pulse has a quote from Washington & Lee’s Timothy Jost, praising the progress. “It’s good considering states are in a bit of a bind,” he tells PULSE. “They widely accept they need to get legislation in place in order to make the 2014 implementation deadlines. But on the other hand they don’t have federal regulations on exchanges or rate review,” so they can’t start writing laws quite yet. Also, with 37 governors seats up in November, advance planning is a challenge. I agree, but to me, just seeing the very same states that are suing the government over reform implementing the law, seems very promising.