The federal government should scrap a proposal to create a national health reinsurance pool and rely instead on state-by-state collections for the program, the organization that represents state insurance regulators told the Department of Health and Human Services Jan. 16. The reinsurance pool that will be created under the Affordable Care Act, which will last from 2014 through 2016, is one of three risk adjustment programs intended to support payments to individual market issuers that cover high-cost individuals. 

In a letter filed after the Dec. 31 deadline for comments on a proposed regulation issued Nov. 30, the National Association of Insurance Commissioners (NAIC) made the point that the United States is not "one national market."  State individual health insurance markets "differ significantly in size and other characteristics," so it makes sense for each state to have its own reinsurance pool, NAIC said.

NAIC also came down on the side of health insurers in its comment letter, saying HHS "should do everything possible to keep fees in [the federally-facilitated exchange (FFE)] as low as possible." HHS proposed a fee of 3.5 percent of individual and small group premiums to fund the FFE, which as many as 20 states may end up with once the main provisions of ACA are implemented in 2014. Health insurers have complained the fee will be too high, and will contribute to higher premiums.