By Barbara Yondorf, Colorado Consumer Health Initiative Board Member and Consumer Representative to the National Association of Insurance Commissioners
The main goals of the Patient Protection and Affordable Care Act (ACA) are to increase access, improve quality and reduce waste in our health care system, in part by reforming the private health insurance market. The National Association of Insurance Commissioners (NAIC) has a lead role in providing advice to the federal government on ACA private insurance reform implementation. It is developing model regulations and laws for states to use to align their laws with the ACA’s health insurance requirements (e.g., coverage of dependent children to age 26, first-dollar coverage of certain preventive services, etc.).
The NAIC has 26 officially designated representatives from state and national consumer health organizations who serve as liaisons to the NAIC to ensure the consumer voice is heard. We serve as a counter-weight to the hundreds of insurance industry representatives who regularly attend and provide input at NAIC’s meetings and hearings. We meet regularly with state insurance commissioners and their staffs, testify, provide data and analysis, and submit written comments on NAIC drafts of model laws and regulations, white papers and resolutions.
To help states and state insurance regulators, the consumer representatives recently issued a report, Implementing the Affordable Care Act’s Insurance Reforms: Consumer Recommendations for Regulators and Lawmakers. The report outlines the issues consumers may face as the insurance provisions are being implemented, and provides policymakers with a roadmap to ensure the reforms meet consumers’ needs. It covers a wide range of ACA insurance reforms, including guarantee issue and renewal requirements, the ban on pre-existing condition exclusions, new restrictions on health status, age and gender rating, essential health benefits, and minimum actuarial value standards. The report outlines the issues consumers may face as these provisions are being implemented, and provides policymakers with a roadmap to ensure the reforms meet consumers’ needs.
Key recommendations in the report include establishing standard open enrollment periods inside and outside state health exchanges, setting national standards for adjusting premiums based on age, limiting insurers’ ability to use benefit design to discriminate against people with health conditions, and closing potential loopholes.
Making sure Coloradans have access to quality health insurance required by the ACA will take collaboration from many stakeholders, including state insurance regulators, state leaders working to establish our state exchange, consumers, consumer advocates, our business community, the insurance industry, community-based organizations and many more. These efforts will result in better access to better health insurance for more Coloradans.