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The State’s Perspective: Early Market Reforms

Numerous consumer protections under the Affordable Care Act (ACA) took effect on September 23, 2010. These “early market reforms” were targeted to fix the glaring gaps in the current market structure, many of which are essential to our community. Examples of reforms include: expanding access to young adults, eliminating lifetime caps, and prohibiting insurers from cancelling people’s coverage when they get sick and denying coverage to children with pre-existing conditions.


The federal requirements under the ACA are implemented on the state level.  This is because states regulate most types of health insurance plans. State flexibility to implement health reform poses significant challenges, since how states choose to implement, write and enforce regulations will determine whether consumers benefit from these new protections. Our collaborators at Georgetown University Health Policy Institute recently looked at states’ actions on 10 early market reforms and found that:

·         49 states and the District of Columbia have taken action on the consumer protections, while Arizona has done nothing

·         23 states and the District of Columbia have chosen a legislative or regulatory approach to implement at least one provision

o    12 states passed new legislation or issued regulation addressing all 10 reforms

·         15 states have issued bulletins or guidelines advising insurers on various provisions

·         11 states have taken “no official action” but their regulatory agencies were reviewing insurer compliance

This highlights the highly variable approach that states have taken in adopting the early market reforms. Moreover, it suggests that policymakers and advocates seeking to understand how states are implementing the ACA look beyond federal regulatory action.


These findings were published in an issue brief for the Commonwealth Fund and on NHF’s advocacy page. The Washington Post recently highlighted these findings and other state efforts.


In collaboration with the Georgetown institute we will be tracking state actions. So stay tuned for updates about when and where implementation is happening in your state. Please check back in mid-May when we will post the most up-to-date information about state efforts in implementing the exchange.

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