Real health-reform battles will be in the states

It's unlikely that this Congress will repeal the health-reform law, so the real battleground is in the states. Huffington Post contributor Don McNay, right, writes that states will adopt health-care reform "kicking and screaming," as shown by the Kentucky insurance department's recent face-off with insurance companies over children's health coverage.

Under the reform act's mandate, insurance companies that offer "child only" policies "cannot deny coverage to a child due to any preexisting condition present in that child," McNay notes. In response, when the provision took effect Sept. 23, 2010, insurance companies stopped offering that type of policy in Kentucky.

State Insurance Commissioner Sharon Clark conducted a hearing on the matter Oct. 13, 2010 and determined that "insurance companies are very concerned about suddenly getting a number of 'bad risks' that they had not planning for in their pricing," McNay reports to his international audience. Clark also determined that if insurance companies stopped offering "child only" policies, the Kentucky Access program for the uninsured would be overwhelmed with new enrollees.

As a result, Clark "ordered all insurers selling individual health insurance policies in Kentucky to offer an annual enrollment each January for children under age 19," McNay notes. "It took strong action by the Kentucky insurance commissioner to get this first part of health reform implemented for a very small part of the population. It's a small battle in a small state for a small set of the population, but a big glimpse of how implementing health care reform nationwide is going to go." (Read more)

Clark works for a Democratic governor who is up for re-election this year. In some states with Republican governors and legislatures, the official atmosphere may not be so friendly.