Insurance Reform Overview 

The Affordable Care Act (ACA)* includes an extensive range of provisions changing how private market health insurance works and how it is regulated. The provisions are of particular importance to state legislatures for two reasons: 1. Many took effect during 2010-2012, or have a series of effective dates stretching from immediate through 2014 and beyond. 2. Many establish more uniform federal standards in areas previously regulated primarily by state laws and state regulations.  In some cases states can choose to have an expanded role, with state regulated and federally regulated (known as ERISA plans) operating in a more transparent or coordinate way.

* The Patient Protection and Affordable Care Act or "PPACA" (Pub. L. 111-148) was enacted on March 23, 2010. The Health Care and Education Reconciliation Act (Pub. L. 111-152) was enacted on March 30, 2010. The federal government and this NCSL material refers to the two statutes collectively as the Affordable Care Act (ACA).

 Here is a sample of recent and popular NCSL items:  

• Health Reform 2011-13  State Legislative Tracking Database - latest listings, with summaries and status for more than 1,000 measures filed, enacted or rejected in 2011-2012; 2013 bills are being added as they are filed.  Updated every two weeks in 2013.

• Key Provisions That Take Effect Immediately (2011 Fact Sheet)

• Health Insurance Reform 2011-2012 Enacted Laws Related to the ACA. - tracking the new state laws implementing early market reforms, in 44 states as of March 2013. 

• State Insurance Mandates and the PPACA Essential Benefits Provisions  - A review of how the 1,800+ existing state mandate benefit and provider requirements, and another 200+ population coverage requirements may be affected by the ACA. Updated for 2013.

• State Actions to Implement the Health Benefit Exchange - Latest results from 2011-2012 legislative sessions; updated for 2013.

• Challenging Certain Health Reforms, State Actions 2012-13- 20 states now have binding measures seeking to prevent state involvement in requiring individuals and employers to purchase health insurance; almost 30 others considered and rejected such legislation in 2010-12. Recent court actions also are listed; updated as of March 2013.

• Right to Health Insurance Appeals Process - A brief describing state appeals laws in 46 states and changes resulting from the ACA.

• Consumer Assistance Programs: Federal and State - state health insurance ombusman programs, expanded with federal grants and guidance.

• Cover Young Adults Up to Age 26 through Parents’ Insurance (State activity) - Federal law effective September 2010.

• High Risk Pools for Health Coverage, State and Federal (State Implementation) - Serving those with pre-existing medical conditions and operational in all 50 states; NCSL report, updated March 2013.

• Rate Review and Approval for Health Insurance - This state Implementation Report describes current state roles and the new federally authorized review process for the 50 states. NCSL report, updated for 2013.

• Medical Loss Ratios: Spending Premium Dollars - The ACA requires insurance companies that issue individual and small employer policies to spend at least eighty percent of the premium dollars collected on medical care and quality improvement activities. State insurance departments are authorized to administer these limits.  10 states had waivers allowing some exceptions to the standard formula as of late 2012.

• Lower Costs in the Medicare Drug Coverage Gap, 2012 -  The ACA provides 50 percent discounts for brand-name drugs when enrollees reach the "donut hole" ($2,810 spending per year). . As of DEcember 2012, about 2.8 million enrollees had saved $5.1 billion dollars. 

• Out-of-state Health Insurance - Allowing Purchases - Reports on three states with laws, out of 18 that have considered such legislation. (updated December 2012)

• State Responses to Insurance Reform: News and Commentary - Articles discussing grandfathered health plans, external appeals, MLRs, employer responses and more.
•  Visit the full with over 80 articles, multimedia, legislative tracking and reports published and posted in the past two years.

 -March 2013