WASHINGTON Only 11 of the 50 U.S. states have moved to implement new consumer safeguards under President Barack Obama's healthcare law, raising questions about how major health insurance reforms will be enforced, a report released on Friday says.
The report by the nonpartisan Commonwealth Fund found 39 states have yet to pass laws or issue regulations on seven reforms, including coverage for people with preexisting medical conditions, a ban on coverage waiting periods and limits for out-of-pocket consumer costs.
The report coincides with the start of a new legislative year for most states and comes 11 months before the reforms are scheduled to take effect under Obama's Patient Protection and Affordable Care Act, which is opposed by many states with Republican leadership.
The law would expand health coverage to more than 30 million people beginning on January 1, 2014, partly by creating new state-based online health insurance markets, or exchanges. These would allow families to buy private coverage at subsidized rates. Seventeen states won conditional approval to operate their own exchanges, while more than 30 have opted for an exchange run by the federal government.
The Commonwealth Fund, which focuses on ways to improve the $2.8 trillion U.S. healthcare system, said states that fail to act on key market reforms could end up lacking the authority to enforce the changes in their home insurance markets and ultimately cede control of those areas to the federal government.
Other reforms that many states have yet to address would restrict insurers from charging more according to a beneficiary's gender, age and health conditions; require coverage of 10 essential health benefits; require plans to cover at least 60 percent of costs; and stipulate that insurers accept every individual and employer that applies for coverage.
"Because insurance regulation falls to the states, states need to take action to make sure they can enforce the law and ensure their residents can fully benefit from it," Commonwealth Fund vice president Sara Collins said in a statement.
The report said that only Connecticut has passed legislation addressing all seven of the new reforms. California has done so for six of the seven. Nine states -- Arkansas, Maine, Maryland, New York, Oregon, Rhode Island, Utah, Vermont and Washington -- have passed laws or issued regulations covering at least one.
The 11 states cited as having taken action on insurance market reform include only nine of the 17 states that have been approved by the U.S. Department of Health and Human Resources to operate their own exchanges.