The PPACA - Implementation Phase I

[FreshFish]

Re: The PPACA - Implementation Phase I

Two of the problems in allowing the sale of health insurance across state lines are in enforcement and in supervision. The latter not as much as the former perhaps.

The insurance commissioner of each state has some responsibility to supervise the solvency and claims'-paying ability of insurance companies that are admitted to do business in his/her state. If you have an insurance company that is not admitted to do business in a given state, yet allow it to sell policies to individuals in that state anyway, how can the insurance commissioner comply with his supervisory responsibilities? he lacks all legal authority.

There is a reason why the insurance company isn't already admitted in the state in the first place; they have to pass insurance commisisoner supervisory scrutiny first. So you have a situation in which a company either hasn't applied in the first place or has applied and was turned down, now bypassing this whole structure.

The same is true for enforcement but even more so. One powerful tool that an insurance commissioner has is the ability to restrict or revoke an insurance company's ability to do business in his/her state. Now you've taken that away as well.

Insurance generally is one of those areas that actually is best left to the states because the nation's population is so diverse and geographic and climatic conditions are so varied. You have 50 centers of localized expertise that know their own situations very well. and they are accountable to the people of their state.

[Rover]

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.

Flag I'm talking about bringing down the costs to the consumer and/or the govt, not to the insurance company. I don't see how buying insurance across state lines brings down the consumer's health care costs or insurance costs. I don't have any objection to it, unless as Fishy correctly states it becomes a logistical nightmare. However, as states set their own laws in this regard, and national insurers would still have to comply with each state's policies, I don't see what this changes.

Fishy - well said.

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Flag I'm talking about bringing down the costs to the consumer and/or the govt, not to the insurance company. I don't see how buying insurance across state lines brings down the consumer's health care costs or insurance costs. I don't have any objection to it, unless as Fishy correctly states it becomes a logistical nightmare. However, as states set their own laws in this regard, and national insurers would still have to comply with each state's policies, I don't see what this changes.

Fishy - well said.

Once again, someone doesn't understand Newton's third law. If you try to punish the insurance companies, where do you think they're going to pass the cost?

[Rover]

Once again, someone doesn't understand Newton's third law. If you try to punish the insurance companies, where do you think they're going to pass the cost?

Umm....Flaggy, let me try to bring this home for you as you seem to be struggling to keep up.

1) I am indifferent as to whether or not you can buy insurance across state lines, because

2) I don't see it making any difference on health care costs


Now, if that takes the stuffing out the strawman you're trying to construct, my apologies. However, you seem to want to get me to argue against insurers selling policies from out of state, I'm speculating because you think this is some sort of liberal position, where in reality I've stated several times I couldn't care less one way or the other. This conversation with you reminds me of when Republicans thought it would really annoy Democrats if they called it the "Democrat Party" instead of the "Democratic Party". I think we missed the memo about how that was supposed to bother us.

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Umm....Flaggy, let me try to bring this home for you as you seem to be struggling to keep up.

1) I am indifferent as to whether or not you can buy insurance across state lines, because

2) I don't see it making any difference on health care costs


Now, if that takes the stuffing out the strawman you're trying to construct, my apologies. However, you seem to want to get me to argue against insurers selling policies from out of state, I'm speculating because you think this is some sort of liberal position, where in reality I've stated several times I couldn't care less one way or the other. This conversation with you reminds me of when Republicans thought it would really annoy Democrats if they called it the "Democrat Party" instead of the "Democratic Party". I think we missed the memo about how that was supposed to bother us.

I only respond to you if you don't get high and mighty about political sides, so it has nothing to do with political leanings whatsoever. Now that we have that cleared up, I was addressing your specific point on how you were trying to lower the cost towards individuals and government, but not insurance companies. The point I was making is that any movement in regulation, whether it's "placed" upon government, insurance, individual, whomever, at the end of the day is passed to the customer. As for Fishy's point regarding enforcement across state lines, he's under the assumption that everything else is going to remain the same. Once you open up insurance across state lines, it then becomes subject to interstate commerce regulations and oversight. The federal oversight of these commissioners would then take precedence. Look, I'm not trying to champion big government or states' rights in this argument, but what I am pointing out is that with the way that this setup was designed, what is legislated is unenforceable because of these state boundary regulations. Given you are adamant that this law should stand as is, I'm merely pointing out the only way that you truly can enforce it without having further lawsuits based around the inability to comply due to state design.

[FreshFish]

Re: The PPACA - Implementation Phase I

As for [Mr.] Fish's point regarding enforcement across state lines, he's under the assumption that everything else is going to remain the same. Once you open up insurance across state lines, it then becomes subject to interstate commerce regulations and oversight. The federal oversight of these commissioners would then take precedence.

That is a terrible idea. We do NOT want federal regulation of insurance. they do not have the competence nor the expertise. Leave it with the states!
> liability insurance has to coordinate with state liability laws
> homeowners insurance has to...
> auto insurance has to ....
> workers compensation insurance has to...
> there are so many different kinds of insurance that have to dovetail with existing state regulations


You want the federal government to have unfettered jurisdiction over the health insurance market? You've just forfeited your libertarian credentials. It would probably make health insurance more costly not less, you think the feds wouldn't start imposing nationwide mandates?

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

That is a terrible idea. We do NOT want federal regulation of insurance. they do not have the competence nor the expertise. Leave it with the states!
> liability insurance has to coordinate with state liability laws
> homeowners insurance has to...
> auto insurance has to ....
> workers compensation insurance has to...
> there are so many different kinds of insurance that have to dovetail with existing state regulations


You want the federal government to have unfettered jurisdiction over the health insurance market? You've just forfeited your libertarian credentials. It would probably make health insurance more costly not less, you think the feds wouldn't start imposing nationwide mandates?

Who said that I actually wanted that sort of thing? You didn't even read the rest of my post, and instead decided to go on your tirade about me. All I have been saying is that if you want to have this law around and you want to be able to enforce it, this is the only way that you can do it. I'll post my beliefs on what must be done given certain prerequisites that have been deemed as "necessary". That doesn't mean it's my beliefs on what we should have.

Do I need to have some tagging system to explain to you people this?!

[Rover]

Given you are adamant that this law should stand as is....

Do you have a surplus of hay wherever you're posting from?

Either that or manure....

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Do you have a surplus of hay wherever you're posting from?

Either that or manure....

This coming from the person who has made at least 15 posts in this and other political threads of "PPACA is law. It was upheld. Like it." or some variation thereof.

[St. Clown]

Re: The PPACA - Implementation Phase I

The intent of allowing people to purchase insurance from across state lines is to allow the public the potential to purchase cheaper insurance from states that do not hold the same mandates for coverage as the state in which the consumer currently resides. It's to create freedom within the market place for the consumer to choose his/her level of coverage. I'm a single man, why should I be mandated to purchase a policy that covers prenatal or mammography care? Why should women be forced to purchase prostate exam coverage? The idea of opening the markets across state lines is to allow the people choice. If I want Cadillac coverage, I'll purchase an all-encompassing plan. If I want something that's only going to cover me in case of an emergency, the old major medical coverage, then I can do just that. It's all about choice, and not dictating said choice to people.

[FreshFish]

Re: The PPACA - Implementation Phase I

The intent of allowing people to purchase insurance from across state lines is to allow the public the potential to purchase cheaper insurance from states that do not hold the same mandates for coverage as the state in which the consumer currently resides. It's to create freedom within the market place for the consumer to choose his/her level of coverage. I'm a single man, why should I be mandated to purchase a policy that covers prenatal or mammography care? Why should women be forced to purchase prostate exam coverage? The idea of opening the markets across state lines is to allow the people choice. If I want Cadillac coverage, I'll purchase an all-encompassing plan. If I want something that's only going to cover me in case of an emergency, the old major medical coverage, then I can do just that. It's all about choice, and not dictating said choice to people.

Agree totally that the concept is very sound.

The challenge is getting your state to allow a stripped down basic catastrophe only plan.

Years ago, a person could buy a policy with a $5,000 deductible or even a $25,000 deductible. As you might imagine, the premiums would be very low. This is ideal for insurance: protect against catastrophic loss, then decide how much you can afford to self-insure under the limit.

States, and now the Feds, have made it harder and harder to buy pure insurance. As you noted, they keep loading it up with all sorts of mandatory features, often with the best intentions at heart (the American Psychological Association wants mental illness to be covered similar to a physical illness, for example; not saying they are right or wrong or whether this is good or bad, merely observing that the more you mandate coverage, the higher the premium becomes).

In practice it is not feasible to allow the sale of health insurance across state lines given the jurisdictional issues involved.

[Rover]

Re: The PPACA - Implementation Phase I

Once again Fishy is dead on accurate. (did I just say that?). I see a sign up the road that reads "Welcome to Bizzaroworld. Population: You"

Clown you will cover mammograms under the concept of a shared burden which is how insurance works. You can't get a policy tailored specifically to yourself, as then we'd have 310M different policies in this country. What your insurance is required to cover will be by and large dictated by state law in the state you live in. Buying a bare-bones policy from Texas will not allow you to escape New York state mandates.

Revisiting a previous topic, this is an excellent article about employers making all their workers part time...

http://www.washingtonpost.com/blogs/..._source=feedly

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Once again Fishy is dead on accurate. (did I just say that?). I see a sign up the road that reads "Welcome to Bizzaroworld. Population: You"

Clown you will cover mammograms under the concept of a shared burden which is how insurance works. You can't get a policy tailored specifically to yourself, as then we'd have 310M different policies in this country. What your insurance is required to cover will be by and large dictated by state law in the state you live in. Buying a bare-bones policy from Texas will not allow you to escape New York state mandates.

Revisiting a previous topic, this is an excellent article about employers making all their workers part time...

http://www.washingtonpost.com/blogs/..._source=feedly

Once again, though, states actually can be overruled by federal will once insurance is able to cross state lines due to the Interstate Commerce clause. That's the price you pay for wanting to enforce a tax with the ability to gain a rebate by purchasing an insurance plan.

Regarding your link, that's actually not all that surprising. To paraphrase the famous quotation, when the door closes, a window opens. One thing that seems to always be forgotten is that labour is an expense for the life of a business, and is very similar to individuals purchasing groceries. With this law, you've just jacked up the price of labour, similar to how one would jack up the price of Cheerios. The demand is not inelastic, though, because there is the part-time option, similar to the store brand of cereal. Welcome to opportunity cost. How much is purchasing full-time labour worth to you?

[FreshFish]

Re: The PPACA - Implementation Phase I

You can't get a policy tailored specifically to yourself, as then we'd have 310M different policies in this country.

Actually, given today's technologies, there should be no reason in theory why a person shouldn't be given a menu of choices regarding coverage, check off what they want, and then see what the corresponding premium would be. You can do something like this with auto insurance already, as long as you at least have the minimum mandated liability coverage*.

The problem as we've both noted is state mandates. If a state were to mandate that you at least had to have catastrophic coverage, and eveything beyond that were elective, then you could pick and choose at many people would like.

It's not a question of states vs feds, it's a question of legislators vs citizens. Legislators receive bribes campaign contributions from various groups and then insert language into legislation favoring those groups. So we have mandatory chiropractic, or mandatory this that or the other, stuck in here and there every now and then and it all adds up to a mess.





* states can regulate in ways that the Feds cannot.

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

I just had a thought:

There's going to be a tax charged upon the people of this country for simply having citizenship. From then, you are able to take a credit by proving your purchase of a federally-approved health plan. That we know. Now, here's the question: How do they plan to collect this? Do they intend to do it through income taxes? Some other method? How do they intend to do the credit? Would they be sneaky enough to throw it within itemized deductions so that it isn't even worth it to much of the population to claim the credit?