The 2010 midterm election is behind us with the Democrats still smarting from a shellacking the likes of which hasn’t been seen in many years.  Clearly the economy and unemployment were significant factors in the Republicans gaining a majority in the House and additional seats in the Senate.  The unpopularity of health care reform was also instrumental in the defeat of many congressmen.  The lawsuit filed by twenty attorneys general declaring it unconstitutional to require individuals purchase health insurance has gained momentum. Speculation as to what will happen to health care reform is prevalent in all media outlets.

The most critical aspect of health care reform is that almost all components are subject to state jurisdiction.  Currently, insurance, Medicare Advantage providers, Medicaid, and high risk pools, for example, must meet requirements set forth by the State Insurance Commissioner. The state imposed regulations impact what health care looks like state by state. Consider some of these small variations:

• Over-the-counter allergy medications maybe available by prescription only in Kentucky.
• Rhode Island has near 20,000 uninsured children in the state—the state is pursuing them more aggressively for enrollment in the children’s health insurance plan.
• Michigan is training more nurse practitioners and physician’s assistants to meet an expected doctor shortage.

In addition to a state’s health insurance commissioner, the governor and attorney general will play an ongoing and considerable role in the implementation of the 2014 health insurance exchanges.  If a state is unable to meet federal guidelines for its exchange, then the state will not be permitted to establish an exchange and will be required to offer its residents a national health insurance exchange.

Addressing the state’s new role in health care reform can be seen in Empowering States to Innovate, a bipartisan bill introduced by Sen. Ron Wyden (D-Ore) and Scott Brown (R-Mass), which would allow states to develop their own plans. The bill would also change the deadlines for compliance with parts of the national reform legislation.

Individuals need to understand what kind of health care is available to them in their own state; especially retirees and pre retirees. For additional information, contact Ellen at EAB HealthWorks.