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State regulators, healthcare industry reps meet to discuss changes to the ACA

The National Association of Insurance Commissioners hosted executives from the America's Health Insurance Plans and the Blue Cross Blue Shield Association to prepare for any transition or repeal of the Affordable Care Act, with hopes of keeping the market stable and prices affordable.

In the traditional closed session called the Commissioners Roundtable, held during the fall national NAIC meeting Dec. 10 in Miami, the America's Health Insurance Plans President and CEO Marilyn Tavenner told state insurance regulators that providing incentives could keep costs down while maintaining insurance coverage for many people. Tavenner recently laid out a roadmap of her thoughts in The Washington Post and said after the presentation at the NAIC meeting that she referred to the points in that article. She said a two-to-three-year transition period for any repeal and replace is necessary, as it takes insurers 18 months to prepare. Tavenner said she was asked about waivers and other matters.

The Blue Cross Blue Shield Association's policy vice president Alissa Fox also presented at the event. Louisiana Insurance Commissioner Jim Donelon said he raised quite a few questions with Fox about the potential repeal and replacement of the ACA and how it would impact states. Blue Cross Blue Shield wants more insurers with them in the state exchanges because in many areas, they are the only ones left, he said. UnitedHealth Group Inc. announced back in April it was rolling back in many exchange markets, and even Blue Cross Blue Shield plans have been pulling back in some state markets, as BlueCross BlueShield of Tennessee announced in September.

The NAIC is preparing for the next steps in the ACA changes in earnest after its 50 state insurance commissioners received a letter dated Dec. 2 from U.S. House of Representatives leaders, including House Majority leader Kevin McCarthy, R-Calif. That letter specifically asked about state implementation of various healthcare reforms and sought ideas for preserving coverage and reducing costs. The letter was written to all state governors as well.

State regulators want to be the key health insurance resources and are the technical experts, NAIC President-Elect Ted Nickel said after the closed session. He said there has been too much federal intrusion over the past eight years in health insurance and other matters, including mortgage insurance. The NAIC has reached out to the Trump transition team, the Wisconsin insurance commissioner said, to offer to help with insurance regulatory matters, including the ACA reforms anticipated.

Congressional leaders are seeking long-term reform ideas and asking what specific parts of the law should be targeted for change in states' Medicaid programs. They also expressed interest in state waivers for innovation under the current law. The letter even asks whether the establishment of a high-risk pool by each state would help return "more choice, control and access" to the state and the officials' constituents if federal law was changed to permit one. A high-risk pool is not a new idea and has worked before in Wisconsin, regulators there have said.