The National Association of Insurance Commissioners' leaders are warning Congress that potential action taken to change the health insurance market could do "irreparable harm" and lead to a rapid collapse of that market.
The letter comes as congressional leaders move forward with an effort to repeal the Affordable Care Act and come up with a replacement.
In a Jan. 24 letter to the chairs and ranking members of the House Ways and Means committee and the Energy and Commerce committee, NAIC leaders also stressed the need for deference to states and flexibility as insurance markets are local. They also spoke out against any legislation that would preempt state authority and licensing laws, warning that certain consumer protections and state solvency requirements would be lost.
The letter also suggested that any replacement plan allow for states to form compacts.
Although state regulators have had different experiences with healthcare reform since the ACA was signed into law, all are concerned, according to the letter, that "things could be worse in 2018 if legislative and administrative actions at the federal level are not carefully considered."
The NAIC leadership, which was made up of the insurance regulators for the states of Wisconsin, Tennessee, Maine and Texas, also noted that uninsured rates have fallen in all states over the past six years. They also pointed out that, under the reform law, "there has been unprecedented access and affordability for the most vulnerable populations."
The letter acknowledges that the individual health insurance markets in some states are struggling, with some "near collapse" and unsustainable. In other states, however, the individual market is robust and marked by stabilized premiums and enrollment.
The NAIC has not heard back from legislators with regard to its letter, but the group is having ongoing conversations with a number of congressional offices.
Oklahoma Insurance Commissioner John Doak wrote a separate letter in response to a request from House Majority Leader Kevin McCarthy, R-Calif., that asked all state insurance commissioners for ACA replacement recommendations. In that letter, Doak suggested examining the use of microinsurance. This type of insurance focuses on low-income populations and has been successful in countries like India, according to Doak, who is potentially vying for a federal position related to insurance in the Trump administration.
"It is time we start thinking differently and move towards more innovative solutions that are working in other countries around the world," he wrote. "We have to start putting in place the processes at the state level to allow for real innovation in this sector, one which has been totally hampered by government intervention for decades."
Doak, who characterized Oklahoma's individual market as being in a state of distress, also suggested permitting sale of insurance across state lines under state regulatory enforcement and adopting policies that expand the use of health savings accounts coupled with high-deductible health plans.