“Before the ACA was implemented, few states had regulations guaranteeing health insurance to people with pre-existing conditions. But the landmark law changed that by attempting to level the playing field across states, while also allowing for some variation. The Supreme Court’s decision making Medicaid expansion optional meant true uniformity was never reached. To make up for the cost of insurers covering extremely ill people, the ACA required everybody to enroll in coverage or pay up.
It also set a floor for benefits that consumers could expect, and then states were free to go above and beyond that minimum, explained Rosemarie Day, a Massachusetts health policy consultant who helped lead the rollout of her state’s Obamacare-like healthcare reform law in 2006.
Now the debates at the state level will be about whether to lower that floor and by how much, Day said, adding that will likely happen along party lines…
Policy experts are skeptical that many states will impose an individual mandate. That piece of Obamacare has been the most unpopular with the American public. But some are experimenting with spinoff versions that frame the mandate in a more positive light. Maryland, for instance, would fine residents for being uninsured, but give them the option of using that money to buy insurance the following year.
“It’s a far friendlier way of doing it, and that I think could gain some traction in the bluer states,” Day said…
“States need to proceed pretty carefully,” Day said. “If people really get sick and need insurance they need that coverage. That’s not a red or blue state issue. That’s just reality.””
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