January 24, 2017
Source: National Academy for State Health Policy
Much has been written about the impact of ACA repeal on consumers and health insurance markets. With this chart NASHP provides an overview of ACA provisions and snapshot of the implications to states if the ACA is repealed. States are the primary regulator of insurance and as such had laws in place prior to the enactment of ACA. Some states repealed those laws and replaced them with ACA provisions, while other states revised their laws but left other old, preempted laws on the books. Sorting through these laws and regulations to have a coherent system of insurance regulation after an ACA repeal will be a complex undertaking in every state. There is a need to proceed thoughtfully with enough predictability to enable insurance carriers to develop rates and plan designs in a timely fashion. This chart looks at what states would likely need to do to comply if the ACA is repealed. Because no clear agreement exists on what a replacement strategy would look like, this chart makes no assumptions about the impact of possible replacement that might address state challenges. Also important to note, the budget reconciliation process can repeal only provisions that directly impact the federal budget. So, using budget reconciliation to repeal ACA could leave other provisions intact, particularly those related to insurance regulation. As a result, the timing of when any ACA provisions are repealed is important to states.