Making Insurance Reform Real in 2014: New Recommendations from the NAIC Consumer Representatives

As federal and state policymakers gear up for the sweeping insurance reforms required under the Affordable Care Act (ACA) to begin January 1, 2014, a broad based group of patient and consumer advocates today released a set of recommendations to ensure the reforms meet consumers’ needs. The report authors serve as appointed consumer representatives to the National Association of Insurance Commissioners (NAIC) and members come from organizations such as the state groups like Health Access California, as well as national groups like the American Cancer Society Cancer Action Network, Consumers Union, the American Heart Association, the Center on Budget and Policy Priorities, as well as academic centers such as Washington & Lee School of Law and Georgetown University.

Beth Abbott of Health Access California, who serves as an NAIC designated consumer representative, noted: “We felt it was important to get these recommendations out now because federal and state regulators are getting ready for 2014. We want to make sure that, as they implement these reforms, they’re putting consumers front and center.” Many of these insurance regulation issues are the subject of pending legislation in California, which need to pass the Legislature in the next three weeks in order for the state to be ready by late 2013.

The report, Implementing the Affordable Care Act’s Insurance Reforms: Consumer Recommendations for Regulators and Lawmakers, covers a wide range of insurance reforms under the ACA, 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.

Sabrina Corlette, a Research Professor at the Center on Health Insurance Reforms at Georgetown University and another one of the report’s co-authors, remarked: “The ACA sets minimum standards to help people access better quality and more affordable insurance. But before people can fully benefit, federal and state regulators need to set clear rules for insurance company behavior, and provide robust oversight. Our recommendations are designed to help them do that.”

Steve Finan, Senior Director of Policy at the American Cancer Society Cancer Action Network noted: “This report provides a detailed blueprint of what needs to be done to create a truly competitive and consumer friendly health insurance market. By making health insurance accessible and comprehensible to the consumer, regulators can greatly affect our long-term ability to improve health outcomes and lower costs.”

Key recommendations in the report include establishing uniform open enrollment periods inside and outside the 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.

“This report analyzes important implementation issues that have been largely ignored so far, such as the potential that the sale of stop-loss insurance to small groups or of unregulated indemnity insurance plans could undermine the consumer and market protection provisions of the Affordable Care Act,” said Timothy Jost, professor of law at Washington and Lee University.

Contributing to the report were NAIC consumer representatives Elizabeth Abbott, Health Access; Amy Bach, United Policyholders; Birny Birnbaum, Center for Economic Justice; Bonnie Burns, California Health Advocates; Sabrina Corlette, Georgetown University Health Policy Institute; Joseph P. Ditré, Consumers for Affordable Health Care; Stephen Finan, American Cancer Society Cancer Action Network; Carrie Fitzgerald, First Focus; Kathleen Gmeiner, UHCAN Ohio; Marguerite Herman, Consumer Advocates: Project Healthcare; Timothy Stoltzfus Jost, Washington and Lee University School of Law; Peter Kochenburger, University of Connecticut School of Law; Adam Linker, North Carolina Justice Center; Sarah Lueck, Center on Budget and Policy Priorities; Jennifer Mishory, Young Invincibles; Stephanie Mohl, American Heart Association; Lynn Quincy, Consumers Union; Andrea Routh, Missouri Health Advocacy Alliance; Barbara Yondorf, Colorado Consumer Health Initiative; and Cindy Zeldin, Georgians for a Healthy Future. 

Health Access California promotes quality, affordable health care for all Californians.