As the Supreme Court prepares to take up the question of the constitutionality of health care reform, a new report finds that almost all the states have begun implementing parts of the Affordable Care Act — suggesting that even the court’s rejection of the measure won’t be able to stop many of the law’s big changes.
According to a new survey from the Commonwealth Fund, “49 states and the District of Columbia have already taken action supporting the law’s implementation, such as passing legislation, issuing regulations or other guidance, or actively reviewing insurer filings.” Between January 1, 2010, and January 1, 2012, “23 states and the District of Columbia had taken new legislative or regulatory action on at least one of these reforms” — which include changes like expanding dependent coverage for young adults up to age 26, prohibiting lifetime limits on health benefits, and phasing out annual dollar limits on health benefits — and an additional 26 states had “taken other action to promote compliance with the reforms, such as issuing bulletins to insurers.” States took the following actions:
— 12 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: expanding dependent coverage for young adults up to age 26, 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.
— 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.
— 15 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.
— 11 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 action.
Indeed, it seems that the law has already created an unstoppable momentum towards change. As Jeffrey Young pointed out yesterday, “health insurance companies, hospitals and the rest of the health care system already have made deep changes to the way they operate: adding new consumer protections to health plans, altering the way medical providers get paid and beginning to work closer together to improve health and save money” — and it’s very unlikely that they will take away these new benefits or obtain efforts to modernize their operations (in an effort to reduce spending). Regardless of the Supreme Court’s anticipated ruling on the law in late June, the changes the ACA inspired are here to stay — in one form or another.