NMI commits to enforcing ACA

Despite some concerns and challenges in implementing the Affordable Care Act on island, the Northern Mariana Islands has confirmed with the federal government its commitment to start enforcing the health care law by next year.

CNMI Commerce Secretary Sixto Igisomar, who is also the state insurance commissioner, affirmed the CNMI’s commitment in a letter to the U.S. Department of Health and Human Services on Monday.

Saipan Tribune learned that HHS had asked the CNMI in a July 12 letter if the Commonwealth can start the substantial enforcement of the ACA come 2014. Igisomar said his Aug. 12 response letter merely informs HHS that the CNMI is working toward “substantially enforcing” the ACA.

“The letter sent from my office is to confirm with only one question, yes or no, to the substantial enforcement of the ACA come Jan. 1, 2014,” Igisomar told Saipan Tribune, adding that the “most immediate plan of action will be dependent upon the response of HHS.”

The Patient Protection and Affordable Care Act, more commonly known as the Affordable Care Act—and Obamacare among its critics—was signed in March 2010. Its intention is to insure all Americans and reduce the costs of healthcare, including regulating the premium rates of health insurance carriers. This law includes several provisions and policies that are being challenged by many states. Igisomar earlier disclosed that one of the challenges the CNMI faces is its ability to enforce market reforms under the ACA. Some examples of these market reforms are pre-existing conditions exclusion; fair health insurance premium; guaranteed availability of coverage; nondiscrimination in healthcare; and many others.

In a letter to Gary Cohen, director of Center for Consumer Information and Insurance Oversight of HHS, Igisomar outlined the CNMI’s concerns and sought assistance from the federal agency.

“I can confirm that the CNMI continues to work toward the ability to substantially enforce the additional consumer protections beginning on Jan. 1, 2014, including the guaranteed availability requirements,” said
Igisomar. However, at this critical moment, he wants the Health Department’s full support in obtaining funding and other resources. Currently, the CNMI receives federal grants for its premium rate review and consumer advocacy program. These grants, however, do not provide for the direct technical and legal support to respond to market reforms.
“The concern this office continues to have is not on the authority of such expansion, but rather the implementation of the federal act. As the enforcement of the market conduct provisions are relatively new to the
insurance division, local regulations are non-existent,” said Igisomar.

He disclosed that the Insurance Division under his department has had neither a robust insurance office operation (personnel and regulatory-wise), nor sophisticated insurance plans that have required any form of
substantial review process. According to Igisomar, although the CNMI will be ready to implement the Premium Rate Review Office and the Consumer Advocacy Program Office, there are other areas of concern
that his office continues to explore as the Jan. 1, 2014, start date nears.

“These obstacles include promulgating the necessary rules and regulations to implement ACA provisions extended to the CNMI such as regulations on open enrollment period and the enforcement of the essential
health benefits provision,” said Igisomar. Also, he said, his office will be working alone to push for additional legislative measures such as an employer mandate and other measures to mitigate the risk pool in the CNMI.

It was earlier revealed that more than 18,000 individuals in the CNMI are not insured with any insurance  carriers and are not even covered by the government-run Medicaid program. This represents 33 percent of the Commonwealth’s 53,800 population, based on 2010 Census.

By MONETH G. DEPOSA
moneth_deposa@saipantribune.com
Reporter