The Affordable Care Act (ACA) included financial and regulatory incentives and goals for states to bolster their health insurance rate review programs, increase their anticipated loss ratio requirements, expand Medicaid, and establish state-based exchanges. The researchers identified changes in states’ rate review programs and anticipated loss ratio requirements in the individual and small group markets since the ACA’s enactment, and linked these changes to the Centers for Medicare and Medicaid Services’ (CMS) criteria for an effective rate review program. They found, of states that did not meet CMS’s criteria when the ACA was enacted, most made changes to meet those criteria, including Republican-controlled states, which generally oppose the ACA. The researchers conclude that federal incentives for states to strengthen their health insurance rate review programs were more effective than the incentives for states to adopt other insurance-related policy goals of the ACA.
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