The PPACA - Implementation Phase I

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Does anyone else find it amusing that the Feds have to prescribe exactly how to set up an insurance exchange?

We've already had one for decades. They call it "the market."

Government interference in the operation of the market made health care more expensive and more inefficient. and of course the solution is even more government interference.

and because the interference became so great, we needed an even more drastic overhaul.

and part of the overhaul is to set up an insurance exchange.

why?

in an attempt to use market forces to improve pricing and options!

Communism at its finest.

[unofan]

Does anyone else find it amusing that the Feds have to prescribe exactly how to set up an insurance exchange?

Are you bi-polar? You've gone from "very, very concerned" to "amused" in the span of what, 12 hours?

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Are you bi-polar? You've gone from "very, very concerned" to "amused" in the span of what, 12 hours?

Amusement in something that is typically of no laughing matter can be a cause for concern.

[Rover]

Actually, the legislators did shoot themselves in the foot a bit. Do you know why they need to set up state-run exchanges, or why states have to be the ones to sponsor Medicare or Medicaid? It's because they kept one of the Glass-Steagall laws where you're not allowed to purchase insurance across state lines. That way, if a state chooses not to set up a state-run exchange that is compatible with PPACA, the PPACA is effectively unenforceable.

Focusing on this one issue, I never understood why people think being able to purchase insurance across state lines is some sort of great untapped health care savings that the gubmint is preventing. If you live in NYC and purchase North Dakota insurance, your insurer isn't going to get to pay North Dakota doctor prices to a provider in Manhatten.

Its similar to how Minny based Geico doesn't charge you according to the going rate in Duluth if you drive in SF or LA or Boston. They charge you what it costs to fix the car where you live.

Lastly, the logistical nightmare that would happen if everyone has access to 1000 different policies would most likely cost more than any savings you'd get for as of now undefined reasons. How would you handle the different laws each state has, even before you get to controversial stuff like abortion or same sex couple coverage?

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Focusing on this one issue, I never understood why people think being able to purchase insurance across state lines is some sort of great untapped health care savings that the gubmint is preventing. If you live in NYC and purchase North Dakota insurance, your insurer isn't going to get to pay North Dakota doctor prices to a provider in Manhatten.

Its similar to how Minny based Geico doesn't charge you according to the going rate in Duluth if you drive in SF or LA or Boston. They charge you what it costs to fix the car where you live.

Lastly, the logistical nightmare that would happen if everyone has access to 1000 different policies would most likely cost more than any savings you'd get for as of now undefined reasons. How would you handle the different laws each state has, even before you get to controversial stuff like abortion or same sex couple coverage?

Something makes me wonder if the same arguments were trying to be made when they were talking about allowing banking to happen across state lines. I do think you're also making an assumption that insurance companies are not going to put forth a behavioral pricing scheme into place, which would include physician costs. The biggest point behind this, however, is that this is what a federally-run exchange would need in order to be set up and effectively enforce the law. In addition, you talk about 1000 different policies. At the time of the start of the enforcement of Glass-Steagall, there were 15,000 different brands of banks. Do you honestly believe there's anything even close to that today? If insurance were allowed to be purchased state lines, would we still have 1000 brands of insurance each trying to put out a policy? Whether or not this creates a too-big-to-fail scenario and the cycle just starts all over again, I don't know if it will happen, but it's certainly a possibility. My point is, though, if you're going to create a federal tax rebate system such as PPACA, it needs to be made federally available in order to be effective.

As for your concern about state laws, I don't see how anything of that sort would change. Just because a policy allows for the coverage of something doesn't automatically mean that it would be taken. As an example, my bank gives me rewards for buying $7 worth of food at Chik-Fil-A. But what do you know? There isn't one close to me. I'd have to go to another state in order to use that. My health insurance could cover me for mammograms as part of a bundle deal in order to get me a lower price, but how much use is that to a guy? What if I want to buy fireworks? I have to go to Pennsylvania for that. Not much different when it comes to health products that aren't available in a state for one reason or another. That's the chance you take.

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Actually, with regards to those state availabilities vs. federal taxation, a lawsuit has been filed. http://www.syracuse.com/news/index.s..._river_default

[Rover]

Re: The PPACA - Implementation Phase I

The problem comes with different pricing based on state mandates.

So for example, lets say one state mandates new mothers have to stay in the hospital for 24 hours after birth to ensure no complications and time to give proper medical advice. Great, but the state next door requires 36 hours.

So, without getting into the pros and cons of a law like this, it stands to reason a policy for State B is going to cost more than State A. But you purchase a policy in State A yet live in State B. So what happens? Most likely the insurance company has to write a policy complying with the laws in the state its operating in, so there's no benefit of crossing state lines to obtain a policy. Any mandates specific to treatment in the state you live in would still apply. Unless you're advocating the Feds hand down a mandate dictating the same level of coverage that overrides all state law...

The problem isn't what's allowed, its what's required. Under federal insurance this is easy because the feds are the higher authority so their policy supercedes state law. Private insurance carries no such legal weight.

[joecct]

Re: The PPACA - Implementation Phase I

The problem comes with different pricing based on state mandates.

So for example, lets say one state mandates new mothers have to stay in the hospital for 24 hours after birth to ensure no complications and time to give proper medical advice. Great, but the state next door requires 36 hours.

So, without getting into the pros and cons of a law like this, it stands to reason a policy for State B is going to cost more than State A. But you purchase a policy in State A yet live in State B. So what happens? Most likely the insurance company has to write a policy complying with the laws in the state its operating in, so there's no benefit of crossing state lines to obtain a policy. Any mandates specific to treatment in the state you live in would still apply. Unless you're advocating the Feds hand down a mandate dictating the same level of coverage that overrides all state law...

The problem isn't what's allowed, its what's required. Under federal insurance this is easy because the feds are the higher authority so their policy supercedes state law. Private insurance carries no such legal weight.

But once the Feds get involved, isn't the historic trend that they keep getting more and more involved??

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

The problem comes with different pricing based on state mandates.

So for example, lets say one state mandates new mothers have to stay in the hospital for 24 hours after birth to ensure no complications and time to give proper medical advice. Great, but the state next door requires 36 hours.

So, without getting into the pros and cons of a law like this, it stands to reason a policy for State B is going to cost more than State A. But you purchase a policy in State A yet live in State B. So what happens? Most likely the insurance company has to write a policy complying with the laws in the state its operating in, so there's no benefit of crossing state lines to obtain a policy. Any mandates specific to treatment in the state you live in would still apply. Unless you're advocating the Feds hand down a mandate dictating the same level of coverage that overrides all state law...

The problem isn't what's allowed, its what's required. Under federal insurance this is easy because the feds are the higher authority so their policy supercedes state law. Private insurance carries no such legal weight.

And you're saying that they don't write the policy to specifically state an amount of time, meaning the new mother has to pay out of pocket for the additional 12?

[Rover]

And you're saying that they don't write the policy to specifically state an amount of time, meaning the new mother has to pay out of pocket for the additional 12?

No I'm saying the out of state insurance company would be forced to comply with the laws of the state the mother resides in, hence there would be no savings for getting a policy across state lines. My best guess is that policy prices are dictated by 1) what providors charge in each state, and 2) what is mandated to be covered by law. Much like getting an out of state company to write you a car insurance policy doesn't change the costs of fixing your car, there would be no savings if the out of state company had to comply with in state laws.

[Rover]

But once the Feds get involved, isn't the historic trend that they keep getting more and more involved??

I'd say it depends. In the post civil rights era after the 60's I think the Feds have been remarkably hands off on voting rights. Maybe a little too hands off if you ask me. Essentually all 50 states + DC conduct elections by their own rules with the biggest exception being you can't discriminate against voters.

Regarding health care, yes I think they have, but also recall the feds are paying the bill.

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

No I'm saying the out of state insurance company would be forced to comply with the laws of the state the mother resides in, hence there would be no savings for getting a policy across state lines. My best guess is that policy prices are dictated by 1) what providors charge in each state, and 2) what is mandated to be covered by law. Much like getting an out of state company to write you a car insurance policy doesn't change the costs of fixing your car, there would be no savings if the out of state company had to comply with in state laws.

So why should that preclude someone from purchasing across state lines? All it does is make part of the requirements uncovered, and when you purchase across state lines, that's the chance that you take. Not to mention, you're still under the assumption that the conglomerates will not just simply merge and provide interstate commerce. After all, you could use that as an excuse to price out those rural "freeloaders" you seem to always bring up.

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

I'd say it depends. In the post civil rights era after the 60's I think the Feds have been remarkably hands off on voting rights. Maybe a little too hands off if you ask me. Essentually all 50 states + DC conduct elections by their own rules with the biggest exception being you can't discriminate against voters.

Regarding health care, yes I think they have, but also recall the feds are paying the bill.

Technically, the states foot the bill and the feds provide reimbursement (state-run exchanges, remember?). I wonder if the federal government would be able to get away with, similar to the highway funds with drinking age and national speed limit from '74-'95, denying a percentage of funds for not setting up the exchanges. The only money they'd be able to collect, though, is the heightened income taxes, because those are the only taxes in this country that do not have to be evenly distributed by census. Just reference the lawsuit I brought up earlier.

[Rover]

So why should that preclude someone from purchasing across state lines? All it does is make part of the requirements uncovered, and when you purchase across state lines, that's the chance that you take. Not to mention, you're still under the assumption that the conglomerates will not just simply merge and provide interstate commerce. After all, you could use that as an excuse to price out those rural "freeloaders" you seem to always bring up.

I have no problem with people purchasing insurance across state lines as long as it doesn't add to administrative costs (which is a possibility). I don't think it saves any money, but if its cost neutral, go crazy.

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

I have no problem with people purchasing insurance across state lines as long as it doesn't add to administrative costs (which is a possibility). I don't think it saves any money, but if its cost neutral, go crazy.

I highly doubt it would cost a company more than six cents to say "I'm sorry, we're only servicing X state" and hang up the phone. I don't know who the heck you're trying to protect in this case, but if I were the owner of an insurance company, and I saw the opportunity to make money off of someone else, you're darn tootin' I'd take it. Not to mention, if that insurance company were a conglomerate (such as BCBS), I already have that upfront work done, so I'd be able to greatly reduce my overhead by having my office in, say, Philadelphia, start bringing in customers from NJ, transfer a few of the NJ workers up to the Philly office, and dismiss the rest. Then the amount that I charge can come down, thereby attracting even MORE customers.