‘Despite lack of mandates, ACA beneficial to CNMI’

While acknowledging that the CNMI is at a disadvantage when it implements the Affordable Care Act in 2014 because of the lack of individual and employer mandates, Department of Commerce staff were one in saying that the ACA will ultimately benefit the islands.

“We really don’t have a choice. It’s a federal law. The CNMI can take over control of implementation or the federal government can come in and control implementation. That being said, there are many benefits from implementing the Affordable Care Act because it sets a benchmark for the CNMI for health insurance regulation,” consumer advocacy officer Caitlyn Neisis-Mocano told Saipan Tribune following Friday’s Society for Human Resources Management-NMI Chapter’s monthly meeting at the Pacific Islands Club Saipan.

Neisis-Mocano, who works for Commerce’s Consumer Assistance Program, and Rate Review Office project manager Brian Sers Nicholas served as guest speakers of the SHRM meeting.

Neisis-Mocano said that before ACA came into play, health insurance regulation was virtually nonexistent in the Commonwealth, which is one reason why the islands are having difficulty with the federal law.

“[Under the ACA in the CNMI] the individual and employer mandates don’t exist. But there are market reforms so insurance companies have to follow more strict rules. They have to offer more benefits coverage and there are more consumer protections as well,” said Neisis-Mocano. “I know a lot of people in the CNMI have pre-existing conditions like diabetes, hypertension…and they can get coverage.”

One problem she foresees is if insurance carriers decide to stop offering individual coverage next year because of the complications of ACA’s implementation in the Commonwealth.

“Then they will only be able to get coverage if their employers offer them coverage. That’s a problem that the CNMI government needs to negotiate with legislators and maybe make it more appealing for insurance carriers to offer an individual plan so we can make sure that everyone gets coverage,” she said.

Neisis-Mocano said the lack of individual and employer mandates puts insurance carriers at a disadvantage because it creates a smaller pool of insured people.

“That’s one of the negatives because we don’t have all of the law applies here. So we only get pieces. But we need all of the law for it to be balanced. The analogy is getting health insurance after you are already sick, just like getting car insurance after you’ve crashed your car. That is not what insurance is for.”

Sers Nicholas agrees with Neisis-Mocano’s analogy and said that individual and employee mandates are key to making ACA work in the U.S. “Unfortunately, it doesn’t apply to the territories.”

“In regards to the amendment made to the Public Health Service Act, the CNMI is included and is considered as a state or a territory. When it comes to the ACA, the courts [however] came out saying that the ACA when referring to states does not include the territories.”

To fix this, Sers Nicholas said the local legislature must pass a law to require universal coverage for everyone—mainland U.S. citizens, locals, and contract workers.

“Contract workers will still be covered. You cannot discriminate on coverage. Our biggest concern is how will we be able to get all these individuals to buy into the plan even without the mandates. Mandates will have to be passed by the Legislature. That’s the only way we can implement and effectuate this,” he said.

Another solution Sers Nicholas’ office is working on is harmonization, which he said involves developing “our processes and procedures together with the territory of Guam.”

“If we are able to include the territory of Guam [in the ACA] we will have a bigger population and we will be able to spread the risk. A bigger risk pool will definitely lower the premiums. One of the things we saw happen was American Samoa had no health insurance carrier before, so what they were allowed to do is partner with Hawaii. Now they get their insurance with Hawaii.”

ACA, otherwise known as healthcare reform or Obamacare, is a federal statute that aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals and the government.