A majority of states haven’t set up their own insurance marketplaces, opting to let the federal government set one up for them. But every one of those states (other than the six in question) have at least said they will police the insurers that sell plans on their federally-run marketplaces to make sure that they aren’t giving consumers short shrift. The Centers for Medicare and Medicaid Services (CMS) will instead be responsible for enforcing Obamacare’s insurance industry reforms and reviewing consumer complaints in the states refusing to do so on their own.
That could be confusing for Americans who are buying insurance for the first time through the marketplaces. For example, imagine you’re a relatively poor person with diabetes. Your income isn’t low enough to get you on Medicaid — but your employer doesn’t offer health benefits, and you’ve never qualified for insurance on the individual market because of your medical condition. On October 1st, you can go buy insurance with government subsidies for the first time on an Obamacare marketplace. But the plan you choose charges you a suspiciously high premium relative to your income. You suspect it’s because of your medical problem, which is clearly illegal under the reform law. But who do you complain to?
Usually the answer is your state’s insurance department. But the answer is CMS if you live in one of the six states that won’t enforce the consumer protections. Unfortunately, if you don’t know that, you could spend months oscillating between the state and federal government, trying to figure out if you’re getting hoodwinked by your insurance company. And in the meantime, the bills are piling up.
Those kinds of scenarios are the reason that health policy experts say insurance complaints are best handled by state agencies. Officials with the Texas Department of Insurance argue that they legally can’t enforce the regulations because they’ve ceded authority over the marketplace to the federal government, and Texas doesn’t have corresponding state laws holding insurers to the same standards as Obamacare. But Stacy Pogue of the Center for Public Policy Priorities tells the Texas Tribune that’s likely a smokescreen, since Texas has enforced plenty of other federal laws on a statewide level in the past.
Officials in the Lone Star State certainly haven’t been shy about their opposition to the health law. Gov. Rick Perry (R) dug in his heels against reform in 2012, saying he wouldn’t “be a part of expanding [the] socializing of our medicine.” More recently, Perry denied basic health benefits to 1.5 million of his state’s poorest residents by forgoing Obamacare’s Medicaid expansion. Evidently, that wasn’t going far enough.
National Republicans have also been stepping up their efforts to to undermine Obamacare. Reps. Tim Huelskamp (R-KS) and Jason Chaffetz (R-UT) are refusing to help their own constituents if they have questions about the health law, and the Tea Party-affiliated advocacy group FreedomWorks has been telling young Americans to forgo signing up for health coverage under Obamacare entirely.