# Is permitting the sale of health insurance across state lines really a conservative position? **URL:** \ **Category:** Great Debates\ **Created:** [July 7, 2015, 9:26pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510 "2015-07-07T21:26:15Z")\ **Posts on this page:** 19\ **Page:** 2
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [July 8, 2015, 2:26pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/21 "2015-07-08T14:26:30Z")
> [@Bone](#): > > Still no cite? Almost all of what you’ve posited seem like hypotheticals, but I suspect even a candidate position would be light on specifics. addressing your points individually [Here](https://www.congress.gov/bill/112th-congress/house-bill/371)is the summary and text of one of the bills proposed in the House to provide this “feature”. The key language in the summary is: “Exempts issuers from any secondary state’s laws that would prohibit or regulate the operation of the issuer in such state, subject to certain restrictions imposed by such state.” Which is exactly what **Fear Itself** is saying. > [@](#): > > I think this is assuming things not necessarily apparent. Why would regulations not apply to policies from out of state? I don’t see how any of your assumptions follow from your hypothetical that you’ve created. See above. Exempting policies from company’s in Texas (primary state) from regulations in California (secondary state) is the express purpose of the proposals. There is nothing hypothetical about it. > [@](#): > > This implies that there would be no regulation within a state. Why do you think that is? Permission to sell across state lines is not immunity from state and local laws. This isn’t how the sale of any other product works, why would this be the case with health insurance? Again, see above. Selling across state lines is legal now. In fact, my policy is from BCBS-Illinois even though I live in Missouri. The catch is that my policy has to conform with MO state laws and regulations of insurance (as well as the federal ACA), even though the issuer is in Illinois. ETA: Another key piece of the bill summary: "Gives sole jurisdiction to the primary state to enforce the primary state’s covered laws in the primary state and any secondary state. " ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [July 8, 2015, 3:36pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/22 "2015-07-08T15:36:23Z")
> [@John\_Mace](#): > > I know you think you’ve found some “gotcha” for conservatives, but this is just spin. The feds have the power to regulate interstate commerce. Period. There is no expansion of power since that power is already there. It takes away the power of states to regulate insurance. Period. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [July 8, 2015, 3:39pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/23 "2015-07-08T15:39:32Z")
Where did anyone get the idea that the Republican party favors smaller government? They pay lip service to that idea but have no problem expanding the federal government when it suits their agenda. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [July 8, 2015, 3:45pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/24 "2015-07-08T15:45:21Z")
> [@Jas09](#): > > [Here](https://www.congress.gov/bill/112th-congress/house-bill/371)is the summary and text of one of the bills proposed in the House to provide this “feature”. The key language in the summary is: “Exempts issuers from any secondary state’s laws that would prohibit or regulate the operation of the issuer in such state, subject to certain restrictions imposed by such state.” Which is exactly what **Fear Itself** is saying. Thanks! This is what I was asking for. Reading the text of the proposed bill however, makes clear that **Fear Itself’s** claim does not hold in this example: > [@Fear\_Itself](#): > > In order for this to be enacted, the federal government would have to take away the authority of the states to regulate insurance, so there would no longer be any regulatory body over insurance. From the text: > [@](#): > > Exemptions From Covered Laws In A Secondary State.—Except as provided in this section, a health insurance issuer with respect to its offer, sale, rating (including medical underwriting), renewal, and issuance of individual health insurance coverage in any secondary State is exempt from any covered laws of the secondary State (and any rules, regulations, agreements, or orders sought or issued by such State under or related to such covered laws) to the extent that such laws would— > > “(1) make unlawful, or regulate, directly or indirectly, the operation of the health insurance issuer operating in the secondary State, except that any secondary State may require such an issuer— > > … > “(G) to comply with any State law regarding fraud and abuse (as defined in section 2795(10)), except that if the State seeks an injunction regarding the conduct described in this subparagraph, such injunction must be obtained from a court of competent jurisdiction; > > “(H) to comply with any State law regarding unfair claims settlement practices (as defined in section 2795(9)); or > > “(I) to comply with the applicable requirements for independent review under section 2798 with respect to coverage offered in the State; The provisions A-F are primarily about NAIC oversight and financial requirements which would still be applicable. In other words, yes many Secondary State regulations would be exempted, but not nearly all. And the idea that there would no longer be any regulatory body over insurance is not even remotely true. > [@](#): > > ETA: Another key piece of the bill summary: "Gives sole jurisdiction to the primary state to enforce the primary state’s covered laws in the primary state and any secondary state. " Here is the actual text: > [@](#): > > “SEC. 2799. ENFORCEMENT. > > “(a) In General.—Subject to subsection (b), with respect to specific individual health insurance coverage the primary State for such coverage has sole jurisdiction to enforce the primary State’s covered laws in the primary State and any secondary State. > > “(b) Secondary State’s Authority.—Nothing in subsection (a) shall be construed to affect the authority of a secondary State to enforce its laws as set forth in the exception specified in section 2796(b)(1). Section 2796(b)(1) are some of the provisions I exerpted above. In other words, the Secondary State will still be able to enforce the Secondary State laws and regulations that are applicable. To summarize, the claims made by **Fear Itself** that are in question: [ol] [li]\*_t would require an Act of Congress to take away from the states the power to regulate the sale of insurance within their own borders._ - not so, Commerce Clause is already in play here.[/li][li]_In order for this to be enacted, the federal government would have to take away the authority of the states to regulate insurance, so there would no longer be any regulatory body over insurance._ - not so, there would continue to be NAIC oversight, as well as Secondary State applicable regulation and enforcement, and Primary State regulation and enforcement.[/li][/ol] ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [July 8, 2015, 3:48pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/25 "2015-07-08T15:48:10Z")
> [@Fear\_Itself](#): > > It takes away the power of states to regulate insurance. Period. Cite? ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [July 8, 2015, 4:21pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/26 "2015-07-08T16:21:16Z")
> [@Bone](#): > > Cite? If **Fear Itself** doesn’t want to provide a cite, I can. He[re you go](https://www.law.cornell.edu/constitution/articlei). I’m not clear on why he thinks this should embarass conservatives, but FWIW. Regards, Shodan ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [July 8, 2015, 5:04pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/27 "2015-07-08T17:04:07Z")
I agree that, in general, the proposed bill is not “unconservative” (whatever that means in this context). What it does highlight (just the last in many examples), is that conservatives don’t really mean it when they mean that the best regulation is local - city if possible, then state, and only federal if absolutely necessary. What they really mean is, less regulation is (almost) always better, regardless of what level it comes from. This is also made clear when conservative state governments override city regulations regarding pollution (I think Texas was the latest example). ETA: A clear example. Suppose Missouri wants to require insurance providers to cover a specific procedure with no copay - it can be anything you want, but for some reason the voters of Missouri strongly feel this is good public policy for their state. The proposed bill would not eliminate the ability for MO to pass such a regulation, but would strongly undercut it by letting employers (the primary purchaser of insurance) chose policies from states without that regulation. This clearly violates the presumed tenant that “the best government is local”. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [July 8, 2015, 6:00pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/28 "2015-07-08T18:00:22Z")
Where in the Constitution does it say “the best government is local”? Conservatives don’t generally go for this “living document” stuff. Regards, Shodan ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [July 8, 2015, 6:05pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/29 "2015-07-08T18:05:56Z")
> [@Fear\_Itself](#): > > Is this really a conservative position, or has it been a Republican talking point for so long, no one really considered what it would entail to implement it? Do they even care? To be perfectly honest, I don’t think a lot of the proposed conservative plans to replace Obamacare has been thought out. They all have the overriding purpose of “Obamacase is evil!” I doubt they have looked beyond just having a different plan ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [July 8, 2015, 7:06pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/30 "2015-07-08T19:06:25Z")
Conservatives generally frown on the federal government extra constitutionally taking over things that should be done by state governments. This is not applicable since regulating interstate commerce is a power that can only be done by federal government and is explicitly authorized in the constitution. Conservatives also like federalism because it limits the damage regulations can do. If those tree huggers in California want to pass a crazy regulation at least the rest of the country does not have to obey. This is not true when the federal government passes a crazy regulation. It is not that state regulations are better, it is just they are limited. Regardless of whether it is from a state, city, or federal government a regulation is interference in the free market and usually destructive. The first best rule would be to get rid of all insurance regulations and let sellers sell what buyers are willing to buy. However, since this is politically unpalatable then letting people buy from less regulated states is better than the status quo. Furthermore, competition for insurance companies might trigger states to lessen the regulatory burden. Legislation should always be judged on whether it makes things better, not whether it is perfect. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [July 8, 2015, 7:27pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/31 "2015-07-08T19:27:41Z")
> [@Shodan](#): > > If **Fear Itself** doesn’t want to provide a cite, I can. > > He[re you go](https://www.law.cornell.edu/constitution/articlei). I’m not clear on why he thinks this should embarass conservatives, but FWIW. > > Regards, > Shodan From the [Republican Platform](https://www.gop.com/platform/we-the-people/): > [@](#): > > We support the review and examination of all federal agencies to eliminate wasteful spending, operational inefficiencies, or abuse of power to determine whether they are performing functions that are better performed by the States. These functions, as appropriate, should be returned to the States in accordance with the Tenth Amendment of the United States Constitution. The GOP giveth. and the GOP taketh away. ---
**Author:** ![That\_Don\_Guy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/that_don_guy/32/538_2.png) [@That\_Don\_Guy](https://boards.straightdope.com/u/That_Don_Guy)\ **Post date:** [July 8, 2015, 7:37pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/32 "2015-07-08T19:37:00Z")
> [@Ruken](#): > > Maybe there are parallels to companies incorporating in Delaware? I think it’s more along the lines of a considerable number of credit card companies issuing cards from South Dakota. It sounds like a “sell from the state with the least regulation” ploy. I have a feeling a lot of insurance companies would love to sell auto insurance in California without having to deal with Proposition 103 restrictions (for example, you can’t charge more to insure a 17-year-old boy than you can for a 17-year-old girl). ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [July 8, 2015, 9:00pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/33 "2015-07-08T21:00:47Z")
> [@Fear\_Itself](#): > > From the [Republican Platform](https://www.gop.com/platform/we-the-people/):The GOP giveth. and the GOP taketh away. Again, not seeing why this is a contradiction. I don’t know many Republicans who believe that Congress fulfilling its Constitutional duties is wasteful or an abuse of power. The GOP did not giveth Congress the power to regulate interstate commerce. That doth be the Conthtitution. Regardth, Thodan ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [July 8, 2015, 9:25pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/34 "2015-07-08T21:25:22Z")
**Fear Itself** - Can you provide a cite, or a supporting argument for these claims? > [@Bone](#): > > To summarize, the claims made by **Fear Itself** that are in question: > [ol] > [li]\*_t would require an Act of Congress to take away from the states the power to regulate the sale of insurance within their own borders._ - not so, Commerce Clause is already in play here.[/li][li]_In order for this to be enacted, the federal government would have to take away the authority of the states to regulate insurance, so there would no longer be any regulatory body over insurance._ - not so, there would continue to be NAIC oversight, as well as Secondary State applicable regulation and enforcement, and Primary State regulation and enforcement.[/li][/ol] ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [July 8, 2015, 9:28pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/35 "2015-07-08T21:28:09Z")
> [@Shodan](#): > > Again, not seeing why this is a contradiction. I don’t know many Republicans who believe that Congress fulfilling its Constitutional duties is wasteful or an abuse of power. > > The GOP did not giveth Congress the power to regulate interstate commerce. That doth be the Conthtitution. > > Regardth, > Thodan The question is not whether the constitution gives the government the power to regulate interstate commerce. It does. That doesn’t mean they must regulate the sale of health insurance within states. The question is, do conservatives argue for state control of regulations only when it suits them? I say they do. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [July 9, 2015, 3:04pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/36 "2015-07-09T15:04:34Z")
> [@Fear\_Itself](#): > > From the [Republican Platform](https://www.gop.com/platform/we-the-people/):The GOP giveth. and the GOP taketh away. The GOP platform says in accordance with the 10th amendment. The 10th amendment says all powers not delegated to the federal government belong to the states or the people. The federal government is expressly delegated the power to regulate interstate commerce in the constitution. An insurance company selling a policy to someone in a different state is obviously interstate commerce. I don’t understand why this is so hard to follow. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [July 9, 2015, 4:13pm UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/37 "2015-07-09T16:13:33Z")
> [@Bone](#): > > To summarize, the claims made by **Fear Itself** that are in question: > [ol] > [li]\*_t would require an Act of Congress to take away from the states the power to regulate the sale of insurance within their own borders._ - not so, Commerce Clause is already in play here.[/li][li]_In order for this to be enacted, the federal government would have to take away the authority of the states to regulate insurance, so there would no longer be any regulatory body over insurance._ - not so, there would continue to be NAIC oversight, as well as Secondary State applicable regulation and enforcement, and Primary State regulation and enforcement.[/li][/ol] I’m not sure what you mean by “the Commerce Clause is already in play here.” The CC is solely a limitation on state power. Even if Congress is not exercising its commerce power, the clause prohibits states from burdening interstate commerce or _from discriminating against interstate commerce_, unless they are acting as a market participant.\* We call this effect the “dormant Commerce Clause” because it exists in the absence of commerce power exercise. So in the absence of enabling federal legislation, a state cannot prohibit an insurance company domiciled in another state from doing business within its borders. It can require that insurer to play by the same rules that its domestic competitors do, but not in all respects. \*In other words, a state can discriminate when it is buying or selling on its own account. That is, Maine can prohibit sales of lumber from its state parks to nonresidents, or require all its police forces to buy patrol cars built in Maine (assuming there were any.) ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [July 10, 2015, 12:10am UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/38 "2015-07-10T00:10:51Z")
> [@puddleglum](#): > > The GOP platform says in accordance with the 10th amendment. The 10th amendment says all powers not delegated to the federal government belong to the states or the people. The federal government is expressly delegated the power to regulate interstate commerce in the constitution. An insurance company selling a policy to someone in a different state is obviously interstate commerce. I don’t understand why this is so hard to follow. I have never disputed the power of the government to regulate interstate commerce. I am pointing out that taking away the state’s power to regulate insurance within the state is not consistent with conservative principles (except when they want it to be). Just because they can doesn’t mean they should, in light of all the other times they have argued that state regulation is better than federal regulation. Why is that so hard to understand? ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [July 10, 2015, 4:35am UTC](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510/39 "2015-07-10T04:35:47Z")
> [@Really\_Not\_All\_That\_Bright](#): > > I’m not sure what you mean by “the Commerce Clause is already in play here.” I was trying to express the idea that it would not require some new power bestowed upon or by congress to do what Fear was suggesting. It’s not super cut and dry, because this is often pushed as bills in congress so by definition these would be acts of congress. The point I was trying to make was that the congress already has the power to regulate or prohibit regulation in the interstate commerce space, this is not a novel concept. This point is clarified below in Fear’s next quote well enough I think this avenue is concluded. > [@Fear\_Itself](#): > > I have never disputed the power of the government to regulate interstate commerce. I am pointing out that taking away the state’s power to regulate insurance within the state is not consistent with conservative principles (except when they want it to be). I think you either have a strawman and/or a Scotsman going on here without a cite or referencing what is supposed to represent the monolithic position of conservative principles. For example, a person could want as little regulation as possible as a primary objective, and as a secondary objective want any regulation that is required to be as local as possible. In this context, there is no conflict even in the hypothetical that you’ve concocted. Add to that the idea that state’s would still have the power to regulate insurance in the only example provided (not by you) and this entire point falls apart. It’s worth a shot one last time - Can you address point #2 in post #24 and repeated in post #34? Specifically, your claim that _“In order for this to be enacted, the federal government would have to take away the authority of the states to regulate insurance, so there would no longer be any regulatory body over insurance.”_ given that the only example provided directly contadicts this asssertion. [Previous page](https://boards.straightdope.com/t/is-permitting-the-sale-of-health-insurance-across-state-lines-really-a-conservative-position/724510.md?page=1)