As the deadline draws nearer for states to achieve certification for their health-insurance exchanges, regulators say the lack of rules and guidance from Washington is holding up the process.
In discussions on the implementation of the Patient Protection and Affordable Care Act (PPACA) during the National Association of Insurance Commissioners' Summer National Meeting, held August 11-14 in Atlanta, regulators and NAIC staff cited delays they are experiencing because the Department of Health and Human Services (HHS) has yet to complete its rule-making process that will govern the exchanges.
Jeremiah Samples, insurance program manager for West Virginia, said before any decision is made, it is important to understand the costs involved in a federal program, but he noted that such an analysis is not possible until HHS issues the rules.
Martin Swanson, assistant project director for the Nebraska Insurance Department, said there are some 200 instances of rule-making that the state is waiting on before it can make an educated decision on what to implement.
Herb Olson, legal counsel for Rhode Island's Office of the Health Insurance Commission, said his state is moving ahead "full tilt" with implementation of its exchange. However, he said rule-making finalization is essential to developing "regulatory alignment" and getting decisions right the first time so states do not lose good health programs they have developed that do not fit into the PPACA.
Olson also warned of a fragmented system of regulation if rules are not developed properly.
Attempting to address some of the regulators' concerns, Tim Hill, deputy director of the federal government's Center for Consumer Information and Insurance Oversight, part of the Centers for Medicare and Medicaid Services, said HHS wants the states to be "in this process."
"We want to meet the states where it is comfortable for them," Hill said, adding that the federal government does not want to be the referee over the state health-exchange markets.
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