National Reform Will Be Implemented Locally

While the Affordable Care Act (ACA) aims to reform healthcare nationally, the way in which the law is implemented will vary on a state-by-state basis.

Earlier this week, several state insurance commissioners met with President Obama to discuss his recent decision to reverse the cancellation of “substandard” individual insurance plans that were in noncompliance with ACA regulations. Commissioners voiced concern as to whether or not they should adopt the president’s proposal to extend existing insurance plans through 2014, and responses were varied.

In Maryland, for instance, CareFirst BlueCross BlueShield said it would provide an opportunity for subscribers to renew policies that were going to be cancelled. In North Carolina, BlueCross BlueShield said it would seek to do the same, but at a rate increase of 16 to 24% for the existing 150,000 policies that would have been cancelled. Some states, like Minnesota, said they would not implement the president’s proposal.

“Regulators are concerned that allowing these plans to continue would mean that some consumers would have health coverage that is less robust than the health law intended. They are worried, too, about the impact on the insurance exchange,” detailed a recent Washington Post article. “The people who currently get low premiums in the individual market are likely to be healthier, and allowing them to keep policies not sold through the exchange could raise premiums for people buying coverage in the new marketplace.”

It is understandable that some states struggle with making sweeping health policy decisions.

Oregon, a state that fully embraced health reform, has yet to enroll one subscriber via its malfunctioning online exchange portal. While residents have the option to register with paper applications, this does not make the process as simple and accessible as the state had hoped. Oregon’s “all-in-one” website was intended to uniquely expand plan options to those who were eligible for Medicaid, but innovating insurance options has not been as successful as it has been in Massachusetts.

Massachusetts’ One Care program, a pioneering managed care program for dual eligibles, has made progress toward the national goal of better coordinating care of dual-eligible beneficiaries. Dual eligibles remain one of the sickest and costliest populations in the country, with an estimated $319.5 billion in expenditures in 2011 alone. One Care’s success is encouraging for other states that are considering similar programs for their Medicaid and Medicare beneficiaries, even with 3 of the 6 MA managed care organizations deciding to depart the program. Robin Callahan, Massachusetts deputy Medicaid director for policy and programs, said that despite the opt-outs and small enrollment so far, the state “is where we need to be to get started.”

Those states willing to make policy changes certainly face risks, but they also have an opportunity to model better ways to deliver healthcare nationally.

Around the Web

Obama Meets with State Insurance Regulators

[The Washington Post]

Oregon Healthcare Exchange Website Never Worked, Has No Subscribers [NBC News]

Mass. Says Launch of Dual-Eligible Program has Gone Well, Despite Half of Plans Dropping Out [Modern Healthcare]