The NAIC wrapped up its annual Fall National Meeting last week, and although there was little of the upcoming debate on the Affordable Care Act (ACA) on the official agenda, the topic dominated the hallway chatter. The NAIC’s meeting workplan was largely set before the election, when most observers expected a different outcome for the fate of the ACA. But there was no way to avoid discussions about the looming Congressional debate in a conference brimming with state regulators and insurance industry representatives, among other stakeholders.
One of the few official discussions of the ACA took place during the Health Actuarial Task Force (HATF) meeting. There, regulators seemed to have their feet firmly planted in the world today, discussing the ACA’s rate review deadlines and risk adjustment program, while keeping an eye on the potential changes ahead – or, as one regulator said, continuing with “the status quo until we know otherwise.” Looking to the Congressional debate to come, regulators discussed the December 2nd letter House Majority Leader Kevin McCarthy sent to all governors and state insurance commissioners, asking for “input and recommendations” on health reform proposals that will replace the ACA. Regulators agreed one frequent GOP health reform proposal – allowing insurers to sell plans across state lines – is “no panacea.” In fact, the NAIC has long had concerns that interstate health insurance sales undermine state authority.
Members of the HATF also heard about the American Academy of Actuaries’ letter to House Speaker Paul Ryan, which warns of the “potential unintended consequences inherent in leaving the individual market without the certainty it requires to remain sustainable” if Congress takes up ACA repeal – even one with a delayed effective date – without a replacement plan. Although on-the-record regulator responses to upcoming ACA repeal and replace debates were limited, privately many regulators shared the AAA’s concern about managing insurance markets in the middle of regulatory uncertainty.
The NAIC’s continued work to implement the ACA is a reflection of the critical role for states in the law known as “Obamacare.” Although the health reform law set a federal floor for private health insurance market reforms and established new marketplaces for small employer and individual coverage, states retain the primary authority to enforce the market reforms. They also have flexibility to enact laws that provide consumers with greater protection. It’s no wonder, then, that the NAIC has been busy in the years since the ACA was signed into law. My fellow NAIC consumer representative, Tim Jost, catalogued that work in a presentation before regulators: “To implement the ACA the NAIC has adopted or amended eighteen model acts and regulations; published five white papers; submitted nearly three dozen comments to Congress and federal agencies; revised and expanded the SERFF system, and extensively revised financial reporting standards and market conduct review standards.”
As all eyes turn to what the new Congress and Administration will mean for health reform, expect the NAIC to split its time, as one regulator in HATF said, on Plan A if nothing changes, and Plan B if health reform undergoes dramatic change. That means more discussion on the ACA while asking to be a partner with the new Administration “in developing and executing any changes” to the ACA.