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Map showing states that have and have not passed new laws or regulations to comply with the Affordable Care Act as of January, 2013.

The Obama administration might be having to take on more than anticipated when the new health insurance regulations included in the Affordable Care Act kick in in 2014. An outgrowth of the protracted legal battle over the law was that states delayed doing much of the work that's required, while they waited to see if the law would stand. That has resulted, the Commonwealth Fund finds, in the majority of states being unprepared to enforce the new insurance regulations, like ending pre-existing conditions.

The enforcement of the new regulations was intended to fall to the states. The analysis shows that only one state—Connecticut—has passed new legislation to enforce all of these new protections, and another 10 (Arkansas, California, Maine, Maryland, New York, Oregon, Rhode Island, Utah, Vermont and Washington along with the District of Columbia) have passed new legislation or issued a new regulation to cover at least one protection. That leaves 39 states lagging.

States have to act this legislative session to get these new laws and regulations in place, or cede that regulation to the feds.

“We don’t know what capacity the federal government has to enforce these protections,” Georgetown’s Kevin Lucia, a co-author of the study, says. “One way or another this will be the law of the land. It’s really a question of are the states going to do the enforcement, and maintain their traditional role, or will the federal government need to step in.” [...]

If a state does not have authority to enforce the Affordable Care Act, that doesn’t mean it becomes null and void: Rather, the enforcement authorities then fall to the federal government.

“It’s a question of both capacity and complexity, whether they have an appreciation for the nuances of each state market,” lead study author Katie Keith, also at Georgetown, says.

This wouldn't be unprecedented; the federal government had to pick up the regulatory enforcement slack for the 1996 Health Insurance Portability and Accountability Act in five states. It's not a terribly onerous burden for the federal government, but not one they intended to have to take on.

And if Republican legislatures and governors are thinking about dragging their heels to try to undermine the law, they might want to think twice. These are the extremely popular consumer protections, the parts of the law that says insurance companies can no longer arbitrarily deny people coverage, or charge them outrageous premiums for the flimsiest of reasons. That's not the stuff to be taking political stands over.

Originally posted to Joan McCarter on Fri Feb 01, 2013 at 08:24 AM PST.

Also republished by Daily Kos.

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