There’s no rest for the weary, the wicked, or health policy wonks; but as our Twitter feeds and inboxes explode with federal news, it’s important to remember how actions in Washington will impact the states. In the past few months, Congress and the Trump Administration have floated a number of proposals and three-pronged plans, many of which put states in the hot seat of implementing and overseeing major changes to the health care system. While there is no clear path forward, it is certain that state regulators will continue to play a critical role in ensuring access to affordable health insurance. In a new report funded by the Robert Wood Johnson Foundation, the National Association of Insurance Commissioners (NAIC) Consumer Representatives outline the potential impact of federal proposals, and how state Departments of Insurance (DOIs) can protect consumers and promote market stability through their role as regulators and advisors to state and federal policymakers.

The group of consumer representatives, ranging from advocacy organization leaders to CHIR’s own JoAnn Volk, identify several proposals that could harm consumers and destabilize state health insurance markets. As these proposals are debated or potentially implemented, the NAIC Consumer Representatives recommend that state regulators provide counsel to policymakers and exercise their regulatory authority to ensure access to health insurance, promote affordability, and provide high-quality coverage to consumers in their state. Here are some highlights from the report:

• If federal legislation brings back high-risk pools without sufficient funding, policymakers could direct funding instead towards a reinsurance program to reimburse plans for high-cost enrollees, like Alaska has done.
• State regulators should be cautious of federal proposals to expand and deregulate Association Health Plans, which could segment the market and undermine state consumer protections.
• As the majority of marketplace enrollees are satisfied with their coverage, expanding the availability of products like high-deductible health plans and Health Savings Accounts would increase out-of-pocket costs for consumers, making health care more expensive and less accessible.
• Proposals that allow insurers to sell health insurance across state lines would compromise state consumer protections and regulatory authority. Evidence suggests that such legislation won’t meet the desired policy goals and could potentially harm consumers.
• Federal changes to Essential Health Benefits and maximum out-of-pocket cost requirements will require state DOIs to step up their oversight of skimpy plans such as indemnity coverage, short-term policies, or discount policies.
• Amidst uncertainty and a range of potential legislative and administrative changes to the health care system, federal and state policymakers will need to invest in consumer education and outreach campaigns.

Today, the uninsured rate is at an historic low. While further reform is needed to ensure more widespread access to affordable coverage, it is vitally important that states maintain and build on the progress made by the Affordable Care Act. The policy road ahead will surely be filled with a number of twists and turns, but these recommendations and others found in the report will support state regulators in their mission to protect consumers and foster a stable insurance market.

You can access the full NAIC Consumer Representatives report here.