Before the Affordable Care Act, health insurance regulation in the individual market largely was managed by the states. The ACA saw a shift to a greater federal role. Now under the Trump administration, some responsibilities are going back to the states.
In a new tip sheet for AHCJ, Louise Norris, whom many AHCJ members know as a contributor to healthinsurance.org, explains the new responsibilities. One significant area is network adequacy – whether a plan has enough doctors, hospitals and other providers to meet the needs of beneficiaries. The other area is drug formulary non-discrimination – did the plan design its drug formulary or marketing to discriminate against people with high-cost health needs?
In addition to being a frequent and respected writer on insurance, Norris brings a broker’s perspective to the healthcare reform discussion, as she and her husband in 2013 started Insurance Shoppers, Inc., a health insurance agency. In 2014, she wrote The Insider’s Guide to Obamacare’s Open Enrollment, a 38-page consumer guide updated for each open enrollment period.