Testifying before Congress this week, Pennsylvania Insurance Commissioner Michael Consedine offered a blistering critique of the way the federal government is coordinating the implementation of the Affordable Care Act.
In particular, Consedine said the U.S. Department of Health and Human Services has failed to issue numerous regulations regarding how states are supposed to implement key parts of the law such as health insurance exchanges.
“Most of these outstanding regulations address critical issues on the operations and requirements of key components of the Affordable Care Act, like health insurance exchanges,” he said at the House Ways and Means Subcommittee on Health Hearing on Wednesday, Sept. 12.
“We still lack clear direction and the flexibility promised us has not materialized, something that at this point poses a significant barrier to our ability to make informed decisions on issues that could impact the lives of millions of Pennsylvanians,” Consedine testified. He said Pennsylvania is not an outlier in “feeling directionless on this road.”Recently, Commissioner Consedine was asked to chair the National Association of Insurance Commissioners’ working group to help identify unaddressed issues with health insurance exchanges. He said that so far, 22 states have signed up to participate in this working group.
“As chair of this working group, my hope is that we may provide the needed direction, guidance, and support for all the states that are travelling on this road together so that we as regulators can help our states make informed decisions and minimize disruptions to insurance consumers and our markets.”
But the lack of detailed information from the U.S. Department of Health and Human Services, he said, “has put Pennsylvania, and many other states, in a very difficult position.”
“We are traveling down a road, directionless, while knowing the road will end soon,” he told the lawmakers. “January 2014 is right around the bend. Pennsylvania, like many other states, needs final rules and guidance on Exchanges in order for us to determine what course is the best for our state.”
Consedine said these concerns and the absence of clear guidance prompted him to write a letter to Health and Human Services Secretary Kathleen Sebeliuss two weeks ago outlining 26 specific questions that Pennsylvania regulators felt needed to be answered to make an informed decision on exchanges.
“As of the date of this testimony, HHS has not responded to our letter,” he said.
“A poorly executed federal exchange launch and transition from current market rules to the new ACA rules could result in severe market disruptions and a weakening of states’ control over their insurance markets,” Consedine told lawmakers.
“Continuing without answers to these crucial issues is like driving down a winding road, at night, without any headlights — nothing good will come of it,” he argued.
He told lawmakers that the final rule on “exchange establishment,” one of the few regulations actually released, had approximately 100 references to “future” or “forthcoming” guidance or regulation.
To date, he said, “I am unaware of any of those regulations being published.”
States are missing details regarding fundamental aspects of exchange operation, like application requirements, citizen and income verification and appeals processes — the list goes on and on, he said. “How is a state expected to develop its own processes to interface with an exchange if the requirements for those functions have not been identified?”
The full transcript of Commissioner Consedine’s testimony can be found on the U.S. House of Representatives’ website (a PDF file).