ACA allows payers to sell plans across state borders, but payers are disinterested — 6 insights

The Affordable Care Act features a provision that allows payers to sell plans across state lines, yet many states have showed minimal interest in the policy, according to The Hill.

Here are six insights:

1. Insurance experts say because states did not express interest in such plans, the government did not complete drafting the rules for how the policy would work.

2. Lindy Blumberg, a senior fellow on health policy at the Urban Interview, noted payers are not looking to do this as the reward is minimal.

3. The health law, however, does contain a provision in which two or more states can form a "healthcare choice compact." Throughout the Untied States, three states — Maine, Georgia and Kentucky — have passed laws allowing them to partake in a healthcare choice impact. Yet, none of these states have made deals with other states to sell plans.

4. Republicans claim the provision falls short in what they envisioned for this practice as payers still have to abide by the ACA's minimum standards when participating in healthcare choice compacts. Minimum standards mandate all health plans cover specific types of providers and services in each network.

5. In 2008, Rhode Island passed legislation to allow payers to sell plans in the state. The legislation called for a study about allowing out-of-state insurance companies to sell plans in the state without additional licensing.

6. However, Rhode Island did not complete the study with Rhode Island Health Insurance Commissioner Kathleen Hittner, MD, noting, "We personally, at this time, do not believe this is a good idea." It is a difficult process as when a payer enters a new marketplace, that payer has to pen contracts with hospitals and providers about providing services. If a payer does not have a presence in the state, it is hard to obtain these contracts.

More articles on coding & billing:
Bundled payments: 4 critical questions for success in the total joint episode of care and beyond
ASC technology budget checklist: 8 areas to include
Delaware Valley ACO renews contract with Humana: 3 takeaways

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Articles We Think You'll Like

 

Featured Whitepapers

Featured Webinars