One
of the most common criticisms of the Patient Protection and Affordable
Care Act (PPACA) is that it constitutes a government takeover
of America’s health care system. By this, of course, is meant
a federal government takeover. PPACA will certainly increase
the federal government’s presence in health care. It imposes
new federal regulations on insurers, creates a new federal program for
funding health insurance for uninsured middle-income Americans, dramatically
expands the Medicaid program, and in all likelihood will increase the
influence of the Medicare program on the organization of the overall
health care delivery system.
Yet
PPACA also expands the responsibility and authority of the states.
The states, for example, are primarily responsible for enforcing PPACA’s
insurance regulatory reforms. They
are also responsible for establishing the exchanges—the entities through
which Americans will purchase insurance and apply for subsidies—and
for managing reinsurance and risk adjustment programs.
According to the Act, states will be responsible for reviewing health
insurance premiums and for assisting consumers with complaints against
their insurers.
However,
PPACA not only increases the authority of the federal and state governments,
it also empowers and assigns significant responsibility to a private
agency: the National Association of Insurance Commissioners (NAIC).
The NAIC is a private, nonprofit organization that has coordinated the
activities of the nation’s state and territorial insurance commissioners
since 1871. Its members are the insurance commissioners
of the states and territories. Traditionally, the
NAIC has drafted model statutes and regulations for the states, served
as a clearinghouse for insurance data, and provided a forum for insurance
commissioners to discuss and address regulatory issues.