OKPOLICY.ORG
Barriers still remain in achieving the real goal of the Affordable Care Act (ACA), to get uninsured Americans affordable healthcare coverage. The Supreme Court created one of these barriers when it ruled that the federal government could not force states to expand Medicaid coverage to all individuals with incomes less than 138 percent of the Federal Poverty Level (FPL). As a result, 14 states, including Oklahoma, have decided or are leaning towards not expanding Medicaid.
The latest barrier is the unwillingness of some states to enforce the consumer protection provisions of the ACA. In states unwilling or unable to enforce these provisions, the Centers for Medicare and Medicaid (CMS) has empowered the Center for Consumer Information and Insurance Oversight (CCIIO) to directly enforce the provisions.
These provisions, which take effect January 1, 2014, reform current health insurance market practices. They are designed to protect health insurance consumers by guaranteeing accessible, affordable, and adequate health insurance plans:
- Accessibility – The consumer protection provisions of the ACA will make health insurance more accessible by requiring that insurers guarantee healthcare coverage to all who apply and prohibiting waiting periods of longer than 90 days.
- Affordability – To ensure affordability of health insurance plans, insurers can only vary rates based on four factors: family composition, geographic area, age and tobacco use. The ACA further limits the variation for age and tobacco use. An insurance company cannot charge an adult more than 3 times the rate of a younger person, and can only charge a tobacco user 1.5 times more than a non-tobacco user. Consumer out-of-pocket cost will also be limited under the ACA and insurers will be required to cover at least 60 percent of the plan’s total cost.
- Adequacy – As a result of the market reforms, insurance companies will no longer be able to exclude preexisting conditions from coverage. The law also outlines ten categories of essential health benefits that must be covered by insurance plans being offered through the insurance marketplace.
Health insurance regulation is primarily a state action. In partnership with the federal government, states are expected to enforce the consumer protections provisions of the ACA. States will be responsible for enforcing the provisions for insurance plans offered inside and outside of the health insurance marketplaces. However, CMS will step in and enforce the law if states notify the agency of their lack of authority or unwillingness to enforce the law, or if CMS finds that a state is not substantially enforcing the provisions.
A report by the Commonwealth Fund found that only 11 states so far have taken legislative action to enforce the ACA insurance market reforms. To be fair, some states already have the necessary legislation in place to enforce these provisions, so no more action is required on their part. However, four states, including Oklahoma, have notified federal officials that they will not be taking action to enforce the consumer protection provisions.
In a press release, Commissioner John Doak explained that the Oklahoma Insurance Department would not be participating in a collaborative effort with CCIIO to enforce the ACA. He also released a letter sent to the CCIIO director explaining his department’s lack of authority to enforce the ACA and his disapproval of subjecting health insurers to a “system of dual regulation.” In the letter, Commissioner Doak expressed his concern regarding the impact these dual regulations would have on Oklahoma consumers.
This system of dual regulation is actually nothing more than requiring insurers to take an extra administrative step to ensure compliance with the ACA. Since Commissioner Doak refuses to enforce the ACA, Oklahoma health insurers will now have to submit policy information and other health insurance plan documentation directly to the federal government. CCIIO will confirm that insurers comply with ACA market reforms and will work with those found to be non-compliant.
For health insurance consumers in Oklahoma, there should be little concern with the federal government regulating health insurance plans. Even some on the right, in our state, have expressed a welcoming attitude in having the federal government enforce the ACA market reforms. Within Wyoming, another state where the federal government will be enforcing the ACA, the outlook for federal enforcement of the ACA is relatively positive.
The Oklahoma legislature could authorize Commissioner Doak to enforce the ACA in the future, but until that time the federal government will ensure that Oklahoma health insurance consumers are receiving the benefits and protections provided by the ACA.
Click here for our other resources and analysis on Medicaid and the Affordable Care Act
If health insurance regulation is a state action, why the need for the federal government to get involved with it in the first place?
There is nothing in the U.S. Constitution that gives the power of health care to the federal government. Thus, since it is not a power of the federal government given to it by the U.S. Constitution, this clearly fits under the 10th Amendment:
“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, ARE RESERVED TO THE STATES respectively, or to the people.”
The federal government needs to end its involvement in a lot of things. Health care is definitely one of them.
Have we so quickly forgotten the reasons why the feds got involved in health care in the first place?
Lack of quality affordable health care.
And the state did not, and will not address this.
Thanks to the health insurance industry.
Steve, that’s false. Oklahoma was one of the best at providing solutions to their population. Oklahoma had a High Risk Pool before the Federal Government created their own. If an individual was uninsurable they were eligible for the coverage. If they were low income and did not qualify for Medicaid they were eligible for help through Insure Oklahoma, which was a Blue Cross Blue Shield plan with excellent benefits and reimbursement from the state…. and if anyone didn’t have insurance and had an emergency they would not be turned away at the hospital.
What the state did NOT have was a government mandate of health insurance coverage, which helps protect income to the hospital and forces healthy individuals to pay more so unhealthy people (some by personal choices, some by hard luck) can pay less.
The Constitution is quite longer than just the 10th Amendment, so focusing on one line isn’t going to be very enlightening. The Constitution does not directly give the federal government the power to regulate jet airliners, for example, but it does so under a thing called the Commerce Clause, which is a federal power and one exclusively reserved for our federal government. That clause and other parts of the Constitution also apply to health care. Conservative Chief Justice John Roberts does a good job of explaining how this works in his opinion (linked below). It all makes sense when he explains it and he’s far smarter than I’ll ever be. Read his opinion and you’ll understand how the law is quite constitutional (as affirmed by the Supreme Court of our land). Federal or state government, they’re both us, and I’m proud of them both. USA!
http://openchannel.nbcnews.com/_news/2012/06/28/12458953-full-text-of-us-supreme-court-decision-on-health-care-laws?lite
Brock, that’s patently false. Having programs in OK doesn’t mean people took advantage of it. The high-risk pool costs money – money that poor people would rather avoid spending and cross their fingers that they won’t get sick (as we all inevitably do. Health insurance is not fire insurance. All of our houses will eventually burn.)
And you’ve got it backward. It’s the current system that allows the uninsured to be treated with the most expensive health-care costs via the emergency room and we responsible citizens pay for their coverage. I think it’s a good idea to demand that adults take responsibility for their own health care, or pay a fine if they decide to foist their inevitable costs onto more responsible and economically capable Americans. Instead of paying for three packs of cigs a day, they should be paying for their inevitable medical costs.
The current private-care system, which gives breaks for people who don’t want to follow personal responsibility, is terrible. It’s the privately based health care system that is the most expensive in the world because it’s driven by profits and produces some of the worst health-care outcomes in the developed world. It is the system that says, “Hey, if you’re low income, better to take your chances and let the other taxpayers and the idiots who buy private insurance pay for it with their higher premiums.” It’s basic market dynamics operating here. The old system of for-profit health care subsidized by taxpayers who pay for the no-profit customers that profiteers won’t take (the poor and the elderly poor) is idiocy for anyone who pays taxes and high private insurance rates.