State Action on 10 Early Market Reforms Under the Affordable Care Act, as of January 2012, via The Commonwealth Fund

According to a new study conducted by The Commonwealth Fund, Florida is among 15 states that are “taking sub-regulatory action to require or encourage compliance with the early market reforms,” required through the Affordable Care Act (ACA).

Since September 2010, a slew of consumer protections in health insurance was mandated by the federal government. Upon the ACA’s signing, states took different approaches to make sure health plans began including those protections. According to Commonwealth, “49 states and the District of Columbia have passed new legislation, issued a new regulation, issued new sub-regulatory guidance, or are actively reviewing insurer policy forms for compliance with these protections.”

Florida was among the groups that issued “sub-regulatory guidance,” meaning the state did the bare minimum to make sure plans included the protections. Florida regulatory officials basically stated that there were changes to standards for health insurance plans, but did not say whether or not they would be enforcing them.

According to the study:

Subregulatory guidance usually expresses the state’s interpretation of existing law, and can include bulletins, memoranda, and notices from the state division of insurance to insurers. Although subregulatory guidance is usually not legally binding, insurers are likely to conform to guidance issued by the state agency empowered to approve or disapprove their product marketing. Such guidance is therefore likely to spur a change in practice, if not in law.

Florida, for example, issued a memorandum to “notify [insurers] of the federal legislative changes that become effective six (6) months after enactment of the Patient Protection and Affordable Care Act,” and instructed insurers to review the law to determine which provisions apply to them.

The memorandum did not say that the state would enforce the early market reforms or otherwise require insurers to comply, and Florida issued the memorandum as “a courtesy to inform [insurers] of new federal requirements.” [emphasis added]

The new protections for consumers include prohibitions on:

  • lifetime limits on the dollar value of essential health benefits
  • plans retroactively canceling coverage, except in the case of a subscriber’s fraud or intentional misrepresentation of material fact, and requires prior notice to the insured
  • plans imposing preexisting condition exclusions on individuals under age 19
  • and plans requiring a referral for obstetrical or gynecological (OB/GYN) care

New requirements and restrictions include:

  • restrictions on annual limits on the dollar value of essential health benefits, unless waived by HHS– and waivers to be discontinued in 2014
  • requirements for plans that provide dependent coverage to make it available until a child turns 26
  • requirement of coverage of specified preventive health services without cost-sharing, such as copayments, coinsurance, and deductibles
  • requirements for plans that provide benefits with respect to emergency services to cover such services without prior authorization, and regardless of whether the provider participates in the plan’s network; requires equivalent cost-sharing for network and non-network providers, and prohibits requirements or limitations on non-network providers that are more restrictive than those imposed on services provided by network providers
  • a requirement that plans allow subscribers to designate any available participating primary care provider (PCP) as their provider
  • and a requirement that plans allow parents to choose any available participating pediatrician to be their children’s PCP

The provision in ACA that allows people under 26 to remain on their parent’s insurance plan has already helped 2.5 million young adults gain health insurance since the law took effect. Starting this fall, one of the preventative services mandated will be contraception coverage, which has drawn fire from religious groups. While the state is doing the bare minimum to enforce this part of the health care reform law, there are other aspects that the state is completely ignoring. State policymakers, for example, have done nothing to even begin planning for the creation of a state health insurance exchange (state-operated health insurance databases that allow citizens to shop around for insurance) that, by law, must be operational by 2014. As the 2012 legislative session wrapped up earlier this month, not a single meeting was held to even discuss the possibility of the state attempting to create an exchange. Federal health officials have warned that if Florida does not have a plan ready by January 2013, the federal government will step in and create one. Florida is currently leading the legal challenge to the Affordable Care Act, which will be heard in the U.S. Supreme Court in less than a week. Gov. Rick Scott has publicly stated that he does not believe the health care reform law is “the law of the land,” and will not implement it until the Supreme Court decides to uphold the law.

You May Also Like