The Role of the States in the ACA

Much of the talk about the state’s role in the implementation of the Affordable Care Act (ACA) has centered around either the Medicaid expansion provisions or the operation of the Marketplaces.  But in reality, that is only a small part of the role the states will play in the implementation and operation of the ACA.

Historically, health insurance has been regulated at the state level. The states approve what health plans can be sold in a state, determine what benefits must be offered and, depending upon the state, will directly or indirectly determine the premiums that health plans can charge for those plans.  If the plan is a network plan, state law will typically establish requirements for network adequacy and what types of providers must be included in the network.

Break Away from the Static

Although the Marketplaces in many states will be federally operated, the ACA does not rescind or override the long-standing state authority to regulate insurance products sold in that state.  Because of that, State Insurance Commissioners continue to have a significant role in how or how well the ACA will work.  State Insurance Commissioners may often be an excellent resource for ACA related questions. 

Click here for a state-by-state list with contact information for the Health Insurance Commissioners in all 50 states.  This chart indicates whether the Marketplace will be state operated, federally operated (aka federally facilitated) or a state/federal partnership.  If you have ACA-related questions, do not overlook this office as a possible resource for answers in that particular state.

ADVOCATE will continue to provide updates as information becomes available.

Best Regards,
Kirk Reinitz, CPA