Reading The Fine Print: Do ACA Replacement Proposals Give States More Flexibility And Authority?

State officials have been heartened by statements from incoming Congressional leadership and the new President that states will gain greater authority and autonomy over their health insurance markets than they have had under the Affordable Care Act (ACA). For example, President Trump’s executive order on the ACA called for giving states “more flexibility and control to create a more free and open health care market.” Similarly, leading members of Congress have said, for example: “States, not the federal government, should have the primary responsibility for health policy,” and suggested that their replacement plans for the ACA will give “power back to the states.” But do the specifics of the plans support these statements? In fact, the fine print in some plans to replace the ACA would take away state authority over health insurance benefit design, premium rates, marketing, and consumer complaint resolution. A close examination of these proposals shows they would turn upside down a longstanding principle of federal-state regulation of insurance, which provides that the states should be the primary source of health insurance oversight and consumer protection, with the federal government only stepping in to set minimum standards or fill gaps. The Federal-State Framework for Insurance Regulation Individual market health insurance has historically been regulated at the state level, with minimal federal involvement. States regulate insurance company solvency and busin...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage interstate insurance States Source Type: blogs