Affordable Care Act State Action Newsletter 13

Affordable Care Act: State Action Newsletter

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July 1, 2011

Mississippi Uses Existing Entity to Establish Health Insurance Exchange

Mississippi is the first state to announce that its high-risk pool program, the Mississippi Comprehensive Health Insurance Risk Pool Association, will establish the state’s health insurance exchange. The independent, not-for-profit association was created in 1991 to operate the state’s high- risk pool– an insurance program that provides coverage for people who want to purchase insurance but cannot obtain it because of health conditions.

Mississippi’s Insurance Commissioner Mike Chaney was interested in moving forward on health exchanges and determined that the association had the statutory authority to establish one, according to Lanny Craft, executive director of the Association. He asked the Association to consider establishing and operating Mississippi’s health insurance exchange, and in May it agreed to do so. Once the association presents a plan, it will need approval from the insurance commissioner and HHS but will not need further legislative action to move forward due to statutory authority it was given in 2009 as the state high risk health pool. “There is an advantage,” Craft stated, “that the organization already has a track record in making medical coverage available and that the organization has experience in providing access to care to a specific population.” Additionally, Craft says that the state likely will establish an advisory board to provide for stakeholder input.

This year, the legislature reauthorized a study panel on exchanges created last year. The panel will examine issues related to exchanges including the effects on insurance carriers, populations needing coverage, its ability to reduce the number of uninsured, projected costs, and models from other states.

New Tool Shows State Progress and Problems

States are improving overall in the quality of their health care, according to 2010 State Snapshots, a Web-based tool released on June 1 by the Agency for Healthcare Research and Quality (AHRQ). Maine, Massachusetts, Minnesota, New Hampshire and Rhode Island showed the greatest improvements in 2010.

Despite overall gains in many states, however, the quality and availability of services minorities and low-income Americans receive remained low across all states.

Visitors to the site can click on an interactive map to view state ratings on a number of measures including: overall health care quality by type of care (preventive, acute and chronic); treatment setting (hospital, ambulatory care, nursing home and home health); and five health conditions (cancer, diabetes, heart disease, maternal and child health, and respiratory diseases).

The 2010 State Snapshots are based on data from the 2010 National Healthcare Quality Report and 2010 National Healthcare Disparities Report, which are produced annually by AHRQ, as required by Congress. Data are drawn from more than 30 sources, including government surveys, health care facilities and health care organizations.

The 2010 State Snapshots comes on the heels of a federal action plan to reduce health disparities called “A Nation Free of Disparities in Health and Health Care” released by HHS in April. For more information, please visit NCSL’s Health Disparities Home Page and NCSL’s Health Disparities Legislation Tracking Page.

Inside This Issue










Massachusetts’ “Second Phase of Health Reform”

On June 28, Massachusetts Governor Deval Patrick sponsored a public hearing on controlling persistent increases in health care costs. He told participants, including state legislators, that “the second phase of health reform is coming, like it or not” referring to the need to control medical costs.

Massachusetts adopted broad-based health reform legislation in 2006 that called for system-wide changes. Several were included in the Affordable Care Act, such as an individual requirement to carry health insurance, development of a health insurance exchange, and expanded coverage options and subsidies for the poor. 

The Massachusetts Division of Health Care Finance and Policy is conducting hearings on health care costs as well. According to Senator Richard Moore, NCSL’s president and Senate chairman of the committee on health care financing, the state “cannot afford the status quo in payment and pricing methodologies.” Moore, among other things, hopes to move the state toward a health care system that is patient focused and promotes primary care and prevention. He states, “it is my intention, this session, to seek value from our health care sector, and find the best methods to allocate the appropriate balance between improved quality outcomes and lower costs through payment and provider price reforms.”

The governor and many legislators want to move to a stronger system of “global payments,’’ in which health professionals are paid a monthly fee per number of patients, rather than being paid for each separate service provided. A June 22 report from the state’s Office of the Attorney General (OAG) warns that shifting to global payments would not likely control rising costs without also addressing provider price disparities and encouraging consumers to make prudent health care purchasing decisions.

Specifically, the report recommends “at least setting temporary statutory restrictions on how much prices may vary for comparable services” in order to “moderate price distortions, without price setting, as a stop-gap until the corrective effects of tiered and limited network products can improve market function.”

The Massachusetts Health Care Quality and Cost Council also recommended comprehensive payment reform in its final report issued October 2009.


CMS Postpones Regulations as States Move on “Health Homes”

Even though the final federal regulations on health homes have been delayed, at least 35 state Medicaid programs operate or are planning to operate medical or health homes for patients with chronic conditions. Health homes are intended to better coordinate and manage the health and long-term care services received by people with chronic diseases. 

A provision of the ACA, called “State Option to Provide Health Homes for Enrollees with Chronic Conditions,” provides federal funding and guidance to states seeking to provide Medicaid health homes or alter their existing programs to comply with the new federal law. The ACA authorizes a temporary 90 percent federal match rate for services to patients with at least two chronic diseases, or one disease and a risk for developing a second, or one serious mental health condition who receive certain services through an approved health home.

Currently, Iowa, Missouri, North Carolina, Rhode Island and Utah have submitted plan amendments to the Centers for Medicare & Medicaid Services (CMS) to take advantage of the ACA provision.  Iowa’s proposed health home will tie providers’ pay to quality measures. Missouri’s model will provide primary care services through community mental health centers.  The state will continue to rely on its existing fee-for-service payment structure; however, it will offer financial incentives to providers who reduce total spending per patient.

The Centers for Medicare and Medicaid services delayed the regulations in order to gather more feedback from the states and providers about how best to proceed with regulating this health service delivery model.  As CMS receives and approves state plan amendments, the agency will rely on previously released guidance to ensure proposals comply with the goals of the ACA. 

Circuit Court Upholds Affordable Care Act

On June 29, the U.S. Sixth Circuit Court of Appeals, in Cincinnati, Ohio, rejected a challenge to the mandatory individual health coverage requirement in the federal law. The court split three ways. Judge Jeffrey Sutton delivered the opinion for the court in Thomas More Center v. Obama, rejecting the facial challenge to the law, which would require the law to be unconstitutional in every conceivable application. Judge Martin upheld the law under the Commerce Clause and Judge Graham dissented.  The case was initiated by the Thomas More Law Center of Ann Arbor, Mich.

See court opinion online.

Register for NCSL’s 2011 Legislative Summit in San Antonio

Legislative Summit Logo

NCSL’s annual Legislative Summit is August 8 – 11, in San Antonio, Texas. Below are the sessions related to the Affordable Care Act.
Click here to register. Hope to see you there!


Monday, August 8

9:00 am - 1:30 pm: NCSL Task Force on Health Reform Implementation:
  • 9:00 am – 9:30 am: Welcome and Introductions
  • 9:30 am – 10:15 am: Secretary Kathleen Sebelius (invited)
  • 10:15 am – 11:00 am: ACA Implementation:  Regulatory and Timetable Challenges
  • 10:45 am - 11:45 am: Insurance Brokers, Agents,  and Navigators:  Issues and Roles
  • 11:45 am – 12:30 pm: Exchanges for Small Businesses (SHOP Act)
  • 12:30 pm – 1:30 pm: Health Insurance Exchanges – How to Address Churning/Unified Coverage/Basic Health Plans

2:00 pm to 5:30 pm: NCSL Health Committee:

  • 2:00 pm – 3:00 pm – Federal Update on Health & Human Services
  • 3:00 pm – 5:30 p.m. Consideration of NCSL Health Policies/Health Committee Business Meeting

Tuesday, August 9

  • 10:45 am – Noon: “Filling the Gap in the Primary Workforce”
  • Noon – 1:30 pm:  Committee Lunch Program — Long-term Care: Home- and Community-Based Options
  • 1:30 pm – 2:45 pm:  Health Insurance Exchanges 
  • 2:45 pm – 4:00 pm: Evidence-Based Care:  Better Bang for the Buck? 
  • 4:00 pm – 5:00 pm: Medicaid Managed Care

Wednesday, August 10

  • 10:00 am – 11:30 am:  The ABC’s of Healthcare Delivery Models: New Approaches to Generating Savings and Improving Quality
  • 1:00 pm – 2:15 pm: States Opting-Out: Health Reform Challenges, Waivers and Alternatives
  • 2:30 pm – 3:45 pm:  States  Transforming Medicaid

Thursday, August 11

  • 8:00 am: – 9:15 am:  Here and Now: States Respond to Health Insurance Reform



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