Michael Consedine, the acting Pennsylvania insurance commissioner, says one challenge for a state regulator trying to implement the Patient Protection and Affordable Care Act (PPACA) is the many gaps in federal PPACA regulation

PPACA, the main component of the Affordable Care Act (ACA) package, requires the U.S. Department of Health and Human Serivces (HHS) and other agencies, such as the Internal Revenue Service, to start many new programs and draft many new regulations and batches of guidance between now and 2014.

Some provisions, such as restrictions on annual major medical benefits limits and new major medical dependent coverage eligibility rules for young adults, are already stating to take effect.

“I think even HHS would agree that there are many critical components of ACA that have yet to be firmly defined and this has led to a general atmosphere of uncertainty and confusion for the states and consumers,” Consedine testified today in Harrisburg, Pa., according to a written version of his testimony provided by the health subcommittee of the House Energy and Commerce Committee.

Rep. Joe Pitts, R-Pa., took his subcommittee on the road to hold a hearing on “PPACA in Pennsylvania: One Year of Broken Promises.”

All of the witnesses who appeared at the hearing attacked PPACA and the rest of the Affordable Care Act, saying it is making coverage more expensive and employers’ lives more complicated.

Republican insurance and health regulators in some states have stopped trying to implement the Affordable Care Act altogether.

Consedine is continuing to proceed with efforts to implement the act in Pennsylvania. The state

has 2,684 enrollees in its PPACA federal health insurance high risk pool program, for example, and it has one of the largest federal risk pool programs in the country.

The federal government is providing about $3.4 million in PPACA planning grants for Pennsylvania, but the government is not helping to pay for the extra rate and product reviews PPACA has required, Consedine says.

“This is a toll that states are expected to pay out of already strained budgets,” Consedine says.

Uncertainty about HHS regulations is also causing problems, Consedine says.

HHS is still working on rate increase disclosure and review regulations, but the Pennsylvania Legislature must give the Pennsylvania Insurance Department new rate review authority almost immediately, without knowing what the regulations will look like, or else HHS officials will take over some Pennsylvania rate review functions in July, Consedine says.

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