The Commonwealth Fund | January 26, 2017Read the Publication
Although the debate over the future of the Affordable Care Act (ACA) focuses largely on federal legislation, repeal and replacement efforts would significantly affect state approaches to insurance regulation.
State-level legislation and regulations help ensure that state regulators have full authority to enforce the ACA market reforms. As of November 2013, 32 states and D.C. had taken legislative or regulatory action to implement at least one of them. States with full enforcement authority can, for example, issue regulations or guidance, undertake market conduct exams, or take disciplinary action related to the law’s consumer protections, such as its ban on denying coverage based on preexisting conditions or charging women more than men. (To learn more about states’ approaches, see this resource and previous reports on implementation of the early market reforms and the 2014 market reforms.)