Leading state insurance regulators wondered aloud during a press conference of the National Association of Insurance Commissioners, held Tuesday in Washington, how states can muscle past a possible rejection by the Supreme Court of the individual mandate under health care reform, yet still have state health exchanges remain viable. What no one at the event could figure out was how to contain health insurance costs without more Congressional fixes if the exchange ever came to be.
Half of the states (26) at most, including the District of Columbia, will be ready for open enrollment in October 2013 for a begin date of the following year, according to the most recent NAIC tally. Exchanges will remain part of the law under all but one option—if the entire law is overturned, one insurance lawyer noted.
Hamm, the Republican North Dakota insurance commissioner (who is up for re-election this year) compared a striking down of the mandate, to pulling a pin on a hand grenade and putting the grenade in the lap of the American people. Hamm also echoed the Administration’s argument that the mandate and requiring insurers to take all comers are interconnected. He noted also that a dangling guaranteed issue, unmoored from the individual mandate, would not work due to skyrocketing costs.
“If folks can jump in and jump out” of coverage, it puts enormous pressure on rate increases and it doesn’t matter how much the subsidies are—they aren’t going to be enough,” Hamm told reporters.
PPACA requires QHP issuers to “authorize the accrediting entity that accredits the QHP issue to release to the [state] Exchange and [to] HHS a copy of its most recent accreditation survey, together with any survey-related information that HHS may require, such as corrective action plans and summaries of findings.”
HHS (whose exchanges adviser Teresa Miller, former Oregon insurance administrator, met privately with her former state colleagues on Tuesday) also been late in issuing rules or doing so as guidance, instead, including some on the exchanges, and its summary of benefits and coverage.