Reflections on the national association of insurance commissioners and the implementation of the patient protection and affordable care act

University of Pennsylvania Law Review

Volumn 159, Issue 6, 2011, Pages 2043-2060

  Jost, Timothy Stoltzfus ^a  

^a NONE

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EID: 79960158504     PISSN: 00419907     EISSN: 19428537     Source Type: Journal    
DOI: None     Document Type: Article

References (55)

1. About the NAIC, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/index-about.htm (last visited Mar. 15, 2011).
2. see also HEALTH CARRIER EXTERNAL REVIEW MODEL ACT (Nat'l Ass'n of Ins. Comm'rs 2010), available at http://www.naic.org/documents/committees-b-uniform- health-carrier-ext-rev-model-act.pdf.
3. See CTRS. FOR MEDICARE & MEDICAID SERVS., CMS PRODUCT NO. 02110, CHOOSING A MEDIGAP POLICY: A GUIDE TO HEALTH INSURANCE FOR PEOPLE WITH MEDICARE 11 (2011), available at http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf (noting that the C and F policies cover one-hundred percent of almost all benefits available).
4. See Letter from Jane Cline, President, Nat'l Ass'n of Ins. Comm'rs, et al. to Kathleen Sebelius, Sec'y, U.S. Dep't of Health & Human Servs., and Hilda Solis, Sec'y, U.S. Dep't of Labor (Dec. 17, 2010), available at http://www.naic.org/documents/committees-b-consumer-information-ppaca-letter-to- sebelius.pdf (providing "the standard definitions and standards for the summary of benefits and coverage" to HHS and the Department of Labor).
5. see also PPACA sec. 1003, § 2794, 42 U.S.C.A. § 300gg-94 (detailing the review process for "unreasonable increases in premiums"). HHS "reviewed and incorporated elements" from this form in developing its own form. CTR. FOR CONSUMER INFO. & INS. OVERSIGHT, DEP'T OF HEALTH & HUMAN SERVS., CMS-10379, SUPPORTING STATEMENT FOR PAPERWORK REDUCTION SUBMISSION: RATE INCREASE REVIEW AND DISCLOSURE REQUIREMENTS 6 (2011), available at http://www.cms.gov/PaperworkReductionActof1995/PRAL/ list.asp (search for document serial number 10379).
6. See Survey on State Authority to Enforce PPACA Immediate Implementation Provisions, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES. (Aug. 5, 2010), http://www.naic.org/documents/index-health-reform-section- ppaca-state-enforcement-authority.pdf (surveying state law on PPACA-related enforcement authority).
7. These include provisions covering adult children up to age twenty-six, internal and external review of adverse coverage decisions, preexisting conditions for children, lifetime and annual limits on care, and rescissions. For links to NAIC draft model laws, see Committees & Activities: Regulatory Framework (B) Task Force, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/committees-b-regulatory-framework.htm (visited Mar. 15, 2011).
8. See Letter from Roger A. Sevigny, President, Nat'l Ass'n of Ins. Comm'rs, et al. to Max Baucus, Chairman, Senate Fin. Comm. (Sept. 30, 2009), available at http://www.naic.org/documents/testimony-0909-officers-to-baucus-healthcare. pdf (arguing for the benefits of the NAIC model-law development process).
9. See Timothy S. Jost, Pro & Con: State Lawsuits Won't Succeed in Overturning the Individual Mandate, 29 HEALTH AFF. 1225, 1225 (2010) (noting the Senate bill's reliance on the states for regulation and enforcement). The House bill, by contrast, would have established a national "Health Choices Administration" and would have charged this entity with implementing the legislation.
10. See Affordable Health Care for America Act, H.R. 3962, 111th Cong. §§ 241-243 (2009) (detailing the responsibilities of the independent agency and its commissioner).
11. See History and Purpose, NAT'L CONF. INS. LEGISLATORS, http://www.ncoil.org/ncoilinfo/about.html (last visited Mar. 15, 2011) (stating that "NCOIL is an adamant, vocal opponent of any Congressional initiative" that runs against its organizational goals).
12. NCOIL Member States, NAT'L CONF. INS. LEGISLATORS, http://www.ncoil.org/ ncoilinfo/member.html (last visited Mar. 15, 2011).
13. See FAQ, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/documents/about-faq.pdf (last visited Mar. 15, 2011) (describing the process of drafting model laws);
14. Model Law Development Framework: Frequently Asked Questions, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/ documents/committees-models-faqs.pdf (last visited Mar. 15, 2011) (setting out the process and criteria for model-law development);
15. Procedures for Model Law Development: Adopted May 2007, Amended September 2008, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/documents/committees-models-procedures.pdf (last visited Mar. 15, 2011) (describing NAIC's model-law development criteria as well as procedures for developing guidelines, the adoption process, and implementing model laws).
16. See Map of NAIC States & Jurisdictions, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/state- web-map.htm (last visited Mar. 15, 2011) (showing that all U.S. states and territories are members of the NAIC).
17. See Business Practices in the Individual Health Insurance Market: Termination of Coverage: Hearing Before the H. Comm. on Oversight and Gov't Reform, 110th Cong. 74-75 (2008) (statement of Abby L. Block, Director, Center for Drug and Health Plan Choice, Centers for Medicare and Medicaid Services) (reporting that only four federal officials were responsible for ensuring that insurers complied with HIPAA "for the entire United States of America").
18. See Actuarial & Statistical Department, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/ actuarial-statistical-dept.htm (last visited Mar. 15, 2011) (describing the actuarial and statistical resources available to the NAIC);
19. Legal Division, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/legal-home.htm (last visited Mar. 15, 2011) (providing an overview of resources available through the NAIC's Legal Division).
20. See The Office of Consumer Information and Insurance Oversight, U.S. DEPARTMENT HEALTH & HUM. SERVICES, http://www.hhs.gov/ociio/index2.html (last visited Mar. 15, 2011) (presenting the OCIIO, the new office within HHS created to implement PPACA requirements such as enforcing insurance compliance, providing state guidance, and compiling data on insurance options).
21. About Us, CENTER FOR CONSUMER INFO. & INS. OVERSIGHT, http://cciio.cms.gov/resources/about/index.html (last visited Mar. 15, 2011).
22. See Helen Lee, CMS Oversight, 14 J. MANAGED CARE PHARMACY S22, S22 to S23 (2008) (describing CMS oversight of these programs).
23. See PATRICK PURCELL & JENNIFER STAMAN, CONG. RESEARCH SERV., RL 34443, SUMMARY OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA) 1 (2009) (noting that the Treasury Department "oversees standards for plan participation, vesting, and funding" and the Labor Department "regulates fiduciary standards and requirements for reporting and disclosure of financial information").
24. See Letter from Jane Cline, President, Nat'l Ass'n of Ins. Comm'rs, et al. to Nancy Pelosi, Speaker, U.S. House of Representatives, and Harry Reid, Majority Leader, U.S. Senate (Jan. 6, 2010), available at http://www.naic.org/ documents/testimony-100106-health-reform-letter-officers.pdf (noting that "[s]tate insurance regulators have extensive experience and expertise in regulating health insurance" and that "[t]hey are closer to consumers and have a better understanding of the markets they regulate").
25. See Timothy Stoltzfus Jost, The Joint Commission on Accreditation of Hospitals: Private Regulation of Health Care and the Public Interest, 24 B.C. L. REV. 835, 840-45 (1983) (detailing the accreditation procedures of the privately run Joint Commission on Accreditation of Hospitals);
26. Timothy Stoltzfus Jost, Medicare and the Joint Commission on Accreditation of Healthcare Organizations: A Healthy Relationship?, LAW & CONTEMP. PROBS., Autumn 1994, at 15, 15-17
27. hereinafter Jost, Healthy Relationship?] (examining Medicare's reliance on the private Joint Commission on Accreditation of Healthcare Organizations to accredit Medicare-financed health services).
28. See U.S. GOV'T ACCOUNTABILITY OFFICE, GAO-07-157, MEDICAL DEVICES: STATUS OF FDA'S PROGRAM FOR INSPECTIONS BY ACCREDITED ORGANIZATIONS 6-9 (2007) (detailing the FDA medical-device accreditation process for private organizations).
29. See NAIC Conference Calls & Interim Meetings Calendar, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/ meetings-calendar.htm (last visited Mar. 15, 2011) (demonstrating the range of topics and indicating that interested parties may participate in calls).
30. See NAIC Exposure Document Index, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/committees-exposure- drafts.htm (last visited Mar. 15, 2011) (displaying the list of the most recent "exposed" documents).
31. see Committees & Activities, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/index-committees.htm (last visited Mar. 15, 2011).
32. See NAT'L ASS'N OF INS. COMM'RS, 2011 COMMITTEE LIST 4-11 (2011), available at http://www.naic.org/documents/committees-cmtelist.pdf (listing the structure and membership of the Plenary and Executive Committees).
33. See Press Release, Nat'l Ass'n of Ins. Comm'rs, NAIC Names 2010 Consumer Liaison Representatives (Mar. 2, 2010), available at http://www.naic.org/ Releases/2010-docs/2010-consumer-reps.htm (listing the 2010 funded and unfunded consumer representatives).
34. See Consumer Participation at NAIC, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/consumer-participation.htm (last visited Mar. 15, 2011) (describing the funded representative program and application process).
35. See 2011 Criteria for Selection, NAIC Funded Consumer Liaison Representatives, NAT'L ASS'N INS. COMM'RS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/documents/consumer-participation-funded-con-Criteria. pdf (last visited Mar. 15, 2011) (presenting preferences and qualifications for funded representatives).
36. see 2011 NAIC Unfunded Consumer Representatives, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/ documents/consumer-participation-unfunded-reps.pdf (last visited Mar. 15, 2011).
37. See Attachments to Letter from Jane Cline, President, Nat'l Ass'n of Ins. Comm'rs, et al. to Kathleen Sebelius, Sec'y, U.S. Dep't of Health & Human Servs., and Hilda Solis, Sec'y, U.S. Dep't of Labor (Dec. 17, 2010), available at http://www.naic.org/documents/committees-b-consumer-information-ppaca-final- materials.pdf (listing membership of the consumer information subgroup).
38. Carl Tobias, Great Expectations and Mismatched Compensation: Government Sponsored Public Participation in Proceedings of the Consumer Product Safety Commission, 64 WASH. U. L.Q. 1101, 1102-10 (1986) (describing an approach that reimbursed individuals for costs of participating in administrative proceedings).
39. See, e.g., Henry H. Perritt, Jr., Negotiated Rulemaking Before Federal Agencies: Evaluation of Recommendations by the Administrative Conference of the United States, 74 GEO. L.J. 1625, 1687-88 (1986) (reporting on "consumer interest representatives' involvement" in an FTC rule revision).
40. See Medical Loss Ratios, 75 Fed. Reg. 19,297 (Apr. 14, 2010) (to be codified at 26 C.F.R. pt. 54, 29 C.F.R. pt. 2590, and 48 C.F.R. pts. 146 & 148) (inviting public comments on implementing PPACA's minimum medical-loss ratio requirement);
41. Premium Review Process, 75 Fed. Reg. 19,335 (Apr. 14, 2010) (to be codified at 48 C.F.R. pts. 146 & 148) (inviting public comments on defining unreasonable premium increases);
42. see also Requests for Comment, U.S. DEPARTMENT HEALTH & HUM. SERVICES, http://www.hhs.gov/ociio/regulations/requests/index.html (last visited Mar. 15, 2011) (requesting public comments on other health care-related regulatory issues).
43. See, e.g., Timothy Stoltzfus Jost, The Necessary and Proper Role of Regulation to Assure Quality of Health Care, 25 HOUS. L. REV. 525, 584 n.331 (1988) (noting that "[t]he usefulness of consumer members of medical boards has been seriously challenged").
44. See Letter from Jane Cline, President, Nat'l Ass'n of Ins. Comm'rs, et al. to Kathleen Sebelius, Sec'y, U.S. Dep't of Health & Human Servs. (Oct. 27, 2010), available at http://www.naic.org/documents/committees-ex-mlr-reg- asadopted.pdf (transmitting the uniform definitions and standard methodologies for calculating minimum-medical-loss ratios);
45. See Draft Letter from Mila Kofman, Co-Chair, Consumer Info. Subgroup, and Teresa Miller, Co-Chair, Consumer Info. Subgroup, to Kathleen Sebelius, Sec'y, U.S. Dep't of Health & Human Servs. (Nov. 15, 2010), available at http://www.naic.org/documents/committees-b-consumer-information-101116-docs-for- adoption.pdf (describing the NAIC's process of developing the standard definitions and standards for summaries of benefits and coverage);
46. See Rate Filing Disclosure Form (Nov. 10, 2010), available at http://www.naic.org/documents/committees-b-rate-filing-disclosure-form.pdf;
47. See generally Timothy Stoltzfus Jost, Writing New Rules for Insurers - Progress on the Medical Loss Ratio, 363 NEW ENG. J. MED. 1883 (2010) (explaining NAIC's role in developing draft regulations to define and calculate PPACA's minimum medical-loss ratio requirement).
48. See, e.g., Jean-Jaques Laffont & Jean Tirole, The Politics of Government Decision-Making: A Theory of Regulatory Capture, 106 Q.J. ECON. 1089, 1090-95 (1991) (explaining interest group politics via an agency framework);
49. George J. Stigler, The Theory of Economic Regulation, 2 BELL J. ECON. & MGMT. SCI. 3, 3 (1971) (arguing that "regulation is acquired by [an] industry and is designed and operated primarily for its benefit").
50. See State Commissioners - 2009, NAT'L ASS'N INS. COMMISSIONERS & CENTER FOR INS. POL'Y & RES., http://www.naic.org/documents/members-state- commissioners-elected-appointed.pdf (last visited Mar. 15, 2011) (listing elected and appointed state commissioners).
51. Beyond the Results: Governors, WASH. POST, http://www.washingtonpost.com/ wp-srv/special/politics/2010-race-maps/governors (last visited Mar. 15, 2011);
52. see also Election Will Mean New Faces in Insurance Commissioner Jobs, INS. J. (Nov. 1, 2010), http://www.insurancejournal.com/news/national/2010/11/ 01/114513.htm (noting that eleven insurance commissioners are directly elected nationwide, and four elections were held in November 2010).
53. See Election 2010: Oklahoma, N.Y. TIMES, http://elections.nytimes.com/ 2010/results/oklahoma (last visited Mar. 15, 2011) (displaying a map of election results).
54. See, e.g., Amanda Gardner, Like Congress, Americans Split over Health-Care Reform, BLOOMBERG BUSINESSWEEK (Dec. 6, 2010), http://www. businessweek.com/lifestyle/content/healthday/646927.html (reporting November 2010 polling data showing that twenty-eight percent supported repealing PPACA, thirty-one percent supported maintaining it, and twenty-nine percent were undecided).
55. Ballot issues opposing health care reform have been passed in Arizona, Missouri, and Oklahoma. Richard Cauchi, State Legislation and Actions Challenging Certain Health Reforms, 2010-2011, NAT'L CONF. ST. LEGISLATURES, http://www.ncsl.org/?tabid=18906 (last updated Mar. 29, 2011).