The Patient Protection and Affordable Care Act (PPACA) could quickly wipe out the commercial health insurance market in five U.S. territories.
The two insurers that have been selling individual coverage in the U.S. Virgin Islands have already stopped selling new coverage because of PPACA fears, according to a subgroup at the Health Care Reform Regulatory Alternatives Working Group, an arm of the National Association of Insurance Commissioners.
Regulators from jurisdictions that are skeptical about PPACA created the working group.
The working group’s territories subgroup says in a PPACA implementation paper draft that any PPACA implementation problems are much more serious in the territories than they are in the rest of the United States because of major gaps in PPACA.
The paper covers American Samoa, Guam, the Northern Mariana Islands and Puerto Rico as well as in the U.S. Virgin Islands
HHS will not be setting up exchanges in the territories, and it will provide only limited Medicaid expansion funding there.
If a territory wants to set up its own territory-based exchange, it can do so, but must come up with the cash to offer the same kinds of health insurance purchase subsidies that mainland U.S. exchanges will offer.