Affordable Care Act State Action Newsletter 24

Affordable Care Act: State Action Newsletter

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January 13, 2012

2012 State Legislative Tracking Database—Coming Soon!

NCSL is launching the 2012 Federal Health Reform: State Legislative Tracking Database on Jan. 17, 2012. In 2011, the database had over 900 bills.  

Topics in the database include: Medicaid, Health Insurance Exchanges, Health Insurance Reform, Health Information Technology, Prevention and Wellness, Providers and Workforce, and Challenges and Alternatives. The last category contains bills that oppose, opt out of, or differ from elements of the federal provisions.

States are expected to address health insurance exchanges, build and upgrade health information technology systems, determine essential health benefit packages, and prepare for Medicaid expansions this legislative session. In 2011, 10 states created health benefit exchanges through legislation, and 42 states passed insurance reform laws to comply with or address requirements in the Affordable Care Act (ACA). The database will include 2011 and 2012 pending, enacted and failed bills and resolutions. Bills can be searched by state, year, topic, keyword, status or primary sponsor. This 2012 legislative database will be online and free to all web users.

High Risk Pools: State Growth and Spending

When Health and Human Services (HHS) created the Pre-Existing Condition Insurance Program to cover patients who had been denied standard health insurance, $5 billion in federal funds was earmarked to cover the costs of establishing the program in all 50 states.

For the first 17 months of operation (July 2010 to November2011), only 44,800 people enrolled nationwide, which was much less than the national projections, resulting in expenditures of less than $445 million (as of September 2011). Because of this, in some states premiums were reduced in 2011 by as much as 40 percent, and other states increased public advertising. [figures updated 1/17/12]

A recent upsurge in enrollments, an increase in severely ill patients, and other state-specific situations, however, are leading to financial challenges in several states. 

Enrollment, which has varied widely across states, almost doubled nationwide from April through October 2011. As of Jan. 8, 2012, nine states that chose to run the program themselves have asked the federal government for more money to ensure their new high-risk pools do not run dry before 2014.

Two of the states so far have been granted additional federal funds.

  • California was given $118 million more to add to the $761 million allocated in July 2010. State officials reported that per-member, per-month costs were more than three times the original estimates by actuaries.
  • New Hampshire initially was given $30 million and expects to receive another $20 million. The New Hampshire Health Plan organization indicated that more funds were needed because the people who enrolled were sicker than anticipated.

Alaska, Colorado, Montana, New Mexico, Oregon, South Dakota and Utah have requests pending with the Center for Consumer Information and Insurance Oversight at HHS.

The Pre-Existing Condition Insurance Program was designed to end in January 2014, when all health insurers will no longer be allowed to deny people coverage for pre-existing health conditions. Another 220,000 people are currently enrolled in 35 traditional, state-run high-risk pools, which do not receive federal funds.

Inside This Issue


New Reports and Research Released

Georgia Health Insurance Exchange Advisory Committee Report to the Governor

Governor Nathan Deal created an Executive Order to establish the Georgia Health Insurance Exchange Advisory Committee which was charged with making preliminary recommendations on a health insurance exchange; this report includes those recommendations. The Committee is composed of legislators, the Commissioner of Insurance, the Commissioner of the Department of Community Health, the Chief Operating Officer of the Department of Economic Development, and others.

Recommendations for a Successful Maryland Health Benefit Exchange

Maryland’s Health Benefit Exchange nine-member governing board was charged with making recommendations on some of the key details of the new state-based exchange before the start of the 2012 legislative session. On Dec. 23, 2011, the board released its report to the governor and the General Assembly. The report includes recommendations on the operating model; market rules and risk mitigation; dental plans; the SHOP; the navigator program; marketing; financing; continuity of care; multi-state and regional contracting, and fraud and abuse. Many of the recommendations will require legislative action.

State of the Uninsured: Health Coverage in Washington State

This report, released by the insurance commissioner in Washington, shows the costs and trends of the uninsured population in the state. The report also makes projections for 2014 and discusses the effects of the Affordable Care Act on the state’s uninsured.

The Federal Basic Health Program: An Analysis of Options for Washington State

This report by the Washington Health Care Authority provides options for the state related to the federal Basic Health Program provision of the ACA.

Evaluation of Wisconsin’s Medical Assistance Program

TheWisconsinLegislative Audit Bureau released this report on trends in Medicaid enrollment and expenditures. It also examines cost containment policies and provides a comparison to other states in the region.

Federally Facilitated Exchanges and the Continuum of State Options

This report from the Study Panel on Health Insurance Exchanges (created by the ACA) explains the option for states to allow the federal government to run the health benefit exchange in their state.

Building the Relationship Between Medicaid, the Exchange and the Individual Insurance Market

This is the second report from the Study Panel on Health Insurance Exchanges that identifies opportunities for collaboration and coordination between the exchange and Medicaid.

Growth in U.S. Health Spending

Health Affairs released this report showing slow growth in health spending in 2010. The report briefly discusses the impact of ACA provisions that took effect in 2010.


Kansas and Oklahoma Denied “Medical Loss Ratio” Waivers

The U.S. Health and Human Services department denied requests from Kansas and Oklahoma for waivers from the ACA requirement that insurance companies issuing individual and small employer policies spend at least 80 percent of the health premiums they collect on health services.

Kansas requested an adjustment of the medical loss ratio standard to 70 percent in 2011, 73 percent in 2012, and 76 percent in 2013. Oklahoma sought an adjustment to 65 percent in 2011, 70 percent in 2012 and 75 percent in 2013. HHS determined that Kansas and Oklahoma failed to present enough evidence that meeting the 80-percent standard would destabilize their individual markets.

Only six of the 17 states to apply for these waivers have been approved; eight have been rejected and three await a determination.


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