Cross-Cutting Issues: Monitoring State Implementation of the Affordable Care Act in 10 States: Early Market Reforms

Abstract

With support from the Robert Wood Johnson Foundation (RWJF), the Urban Institute and Georgetown University's Center on Health Insurance Reforms are undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the Patient Protection and Affordable Care Act of 2010. The project began in May 2011 and will take place over several years. The Urban Institute will document changes to the implementation of national health reform in Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia to help states, researchers and policymakers learn from the process as it unfolds. This report is one of a series of papers focusing on particular implementation issues in these case study states. In addition, state-specific reports on case study states can be found at the Robert Wood Johnson Foundation and Health Policy Center websites. The quantitative component of the project is producing analyses of the effects of the ACA on coverage, health expenditures, affordability, access and premiums in the states and nationally. For more information about the Robert Wood Johnson Foundation’s work on coverage, visit their website.This paper describes the implementation of the early market reforms in the 10 states participating in the Robert Wood Johnson Foundation’s monitoring and tracking project. Information is drawn from publicly available sources, state legislation, and site visit interviews in each of the 10 states. Each state took some action to require or encourage insurers to comply with these reforms. Although some challenges were noted, informants in all 10 states reported that insurers are generally complying with the early market reforms; regulators are hearing few consumer concerns, and premiums have not risen substantially because of these reforms. Compliance was largely facilitated through the efforts of state regulators, insurers and consumer advocates. To a large extent, the actions taken by these states reflect the diversity of approaches that exist among states nationwide.