As State Legislative Sessions Begin: Have You Done Your Homework?

Most state legislative sessions have just started or will begin in the next few weeks. It might be a good time to focus on some key health reform implementation homework: developing a plan that measures provisions of the ACA against existing state laws and identifies potential changes. Having a legislative plan can bring order to the many needed changes to state law, ensure that necessary fixes are not left out of legislation, and prevent the need for technical corrections later. The plan could be organized by section of the ACA, state legislative committee of jurisdiction, and/or by state executive branch agency or staff person responsible for implementation. Both executive and legislative branches could play a role in drafting and using this type of plan.
While this type of legislative plan may exist on state legislative and executive branch staffer’s desks, at State Refor(u)m we have yet to get our hands on a full prototype. (Please send it our way if you have one!) However, we have found a few helpful places to get started using resources on State Refor(u)m and a few other websites of interest:

1. Washington’s Medicaid agency drafted a matrix of ACA provisions related to low-income populations and programs. The matrix includes the effective date of the ACA provision, the lead agency staffer responsible for tracking, whether legislation is needed, whether the fiscal impact is known, and more. This is an early draft of the document that the agency is still using, but may be a useful template for other states.
2. There is helpful state legislative analysis lurking within more comprehensive state reports about implementation. Here are a few highlights:
   1. Impact Arizona: Health Reform Hits Arizona – Individual sections of this larger report highlight key provisions of ACA, the status of state law on these issues, and related policy issues. For example, on page 14 the report discusses ACA’s medical loss ratio requirements and notes that Arizona law currently does not require particular medical loss ratios.
   2. Implementing National Health Reform in California: Changes to Public and Private Insurance – Each section of this paper includes key components of ACA and then discusses areas for federal guidance and possible state policy changes. For example, on pages 28-40, the document suggests that California may need to pursue regulatory and legislative changes on a number of private health insurance requirements, including: internal claims and appeals, guaranteed issue and renewability, preexisting condition exclusions, and more.
   3. Implementing Health Care Reform: A Roadmap for Colorado – One section of this report, on pages 13-14, highlights potential state legislation changes in the areas of insurance, exchanges, delivery reform, workforce and Medicaid eligibility. The section also mentions that some state departments, like the Colorado Department of Human Services, might need added authority to apply for federal grant opportunities.
3. The National Conference of State Legislatures is keeping a map and a regularly updated tableon state actions to implement federal health reform. Most of the legislation noted relates to a particular aspect of reform, such as California’s exchange law, or state laws creating advisory boards for implementation. We expect to see a lot more activity here in the coming year.

Does your state have a legislative plan to share with other states? Please send them—and any other health reform-related materials—to State Refor(u)m.