Will Reluctant States End Up Embracing the Health Reform?

Aug 29, 13 Will Reluctant States End Up Embracing the Health Reform?

By Martha C. Rivera, Director of Strategy and Insights

Likely, everybody in the country has heard something about the fierce battle that surrounded health care reform. Lawsuits, Supreme Court appeals, federal funding rejections and prohibiting implementation via state laws of one or several of the ACA components were highly visible happenings repeatedly seen since the signing of the law, in March, 2010.

As the deadline to execute one of the most comprehensive components of the ACA in terms of the size of the population to be covered —the state’s Health Exchanges should be up to speed for enroll on October 1, 2013— a main discussion point remains unclear: would the ACA implementation ever be general across the entire country?

An aspect to keep in mind when attempting to provide an answer is that the ACA is a multiple-component law where some components do not have deadlines or are subjected to federal-based execution instead of state-based.

Four basic ACA components are Medicare, Small Business Exchanges, Individual Insurance Health Exchanges and Medicaid Expansion. The Federal government started implementing the ACA Medicare component, which focuses on closing the Medicare Part D donut hole by 2015, through important reductions of the cost of drugs to Medicare beneficiaries or rebates. The Small Business Exchanges deadline, which is to be implemented by each state, was recently postponed throughout 2015. The Medicaid Expansion, another state-based component, has been rejected in only 4 states, while the remaining are either considering their decision or moving forward within early implementation stages. The State Individual Exchanges remain a highly visible state-based component that has been rejected by an important number of states. As of May 28, 2013, 24 states including Washington D.C. are moving forward with setting up their exchanges either independently or through various forms of partnerships with the federal government level, while 27 states remain opposed to the reform and consequently their population qualifying for individual insurance will need to enroll through a sort of federally run macro-exchange.

Nobody can solidly predict whether or not those reluctant states will “change their minds.” After some time passes, The ACA’s real benefits and shortcomings may be apparent in the implementing states. It is true that the topic has a high degree of political sensitivity, among some. However, if the ACA achieves its purposes of increasing access to affordable health care and reducing health-related costs, refractory politicians might reconsider that they would be leaving their voters most sensible needs in the hands of the federal government a critical factor of and wish to play a role in it. Let us wait and see.

The Affordable Care Act of 2010: May 2013 Progress Report. Deloitte. www.deloitte.com/us/ACAprogressreport.
State Decisions for Creating Health Insurance States as of May 28,2013. Kaiser Foundation. http://kff.org/health-reform/state-indicator/health-insurance-exchanges/#map

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