States Likely to Play Bigger Role in Health-Care Reform


States may end up with more authority to implement health-care reform under the in-coming Trump administration.

That’s the prediction I heard from a former Obama administration official who ran the Obamacare health insurance exchanges.

“If anything, we are going to see now even more delegation aggressively back to the states” concerning issues such as what benefits must be covered by health insurers, Joel Ario, managing director of consulting firm Manatt Health, said at a recent briefing I attended in Washington by free market think tank American Enterprise Institute.

State regulators have already played a big role in drawing up regulations under the Affordable Care Act and certifying exchange plans and premium rates, Ario noted. State regulators have more expertise in regulating their state markets, he said.

Yet there are only 13 ACA exchanges operated by states in 2016, and in 2017 there will be only 12 because Kentucky has switched from operating its own exchange to relying on the federal exchange.

That means the federal government has had to rely on states to perform more regulatory functions, Ario said.

In a separate interview, Ario told me he thinks that delegating more power to states is something that will happen in the future rather than immediately. The initial issues for President-elect Donald Trump and the incoming Republican-led Congress will be how to repeal and replace the Affordable Care Act without taking away coverage people have gotten used to, he said.

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