The PPACA - Implementation Phase I

[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....shington_more_chall.html#incart_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.

 

[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.