# The Repeal of Obamacare/ACA: Step-bystep, Inch-by-inch **URL:** \ **Category:** The BBQ Pit\ **Created:** [January 2, 2017, 5:06pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146 "2017-01-02T17:06:13Z")\ **Posts on this page:** 20\ **Page:** 76
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 13, 2017, 6:44pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1501 "2017-10-13T18:44:03Z")
> [@Slash1972](#): > > This is the part I don’t understand. I know that direct comparison to car insurance isn’t the best, but each state has minimum liability insurance requirements for its residents. Any car insurance policy I buy has to meet the Maryland minimum liability standards for car insurance. Wouldn’t health insurance work the same way, regardless of where the company is actually located? That is how it is now. “Allowing competition across state lines” would change that. If you could buy car insurance the way you would be able to buy health insurance, then you could buy policies that do not meet Maryland’s liability standards. It is not that the companies are not allowed to operate in different states, just as you have Allstate and State Farm in pretty much (if not all) states, you also have Blue Cross and Anthem in pretty much all (if not all) states. It is the policies that they offer that are regulated by the states they are sold into. That is what they want to change. ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [October 13, 2017, 6:52pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1502 "2017-10-13T18:52:11Z")
> [@k9bfriender](#): > > That is how it is now. > > “Allowing competition across state lines” would change that. If you could buy car insurance the way you would be able to buy health insurance, then you could buy policies that do not meet Maryland’s liability standards. > > It is not that the companies are not allowed to operate in different states, just as you have Allstate and State Farm in pretty much (if not all) states, you also have Blue Cross and Anthem in pretty much all (if not all) states. > > It is the policies that they offer that are regulated by the states they are sold into. That is what they want to change. So they want to pass a law that says states cannot set mandatory insurance minimums? Repeal a law that says the states can? Something else? I haven’t heard many specifics other than “Sell across state lines”. ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [October 13, 2017, 6:59pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1503 "2017-10-13T18:59:06Z")
Here’s what I don’t understand. I was on various “association” health care plans for about 10 years. I found the plans through a broker but they were offered by various groups with names like Federation of American Businesses. They were good at first but over time the plans got more expensive and crappier and the options were fewer. Until I was down to one organization that offered one horrible plan from a cut-rate insurer. Now it’s my understanding that the reason these plans became an unattractive option was because insurers decided it wasn’t a good deal for them and that too many unhealthy people were signing up for them. A lot of the small business owners that I know routinely have their payroll audited by their health insurers to make sure they aren’t covering anyone they aren’t employing. So why do they think insurers are going to have any interest in offering health plans to associations? And why do they think insurance companies are going to want to set up plans outside their states? It’s not like they can just open their existing plans to anyone – well I guess they could but the provider networks are currently only statewide and I would think that having to travel across the country to go to a doctor would be a deal breaker. ---
**Author:** ![filmore](https://avatars.discourse-cdn.com/v4/letter/f/7993a0/32.png) [@filmore](https://boards.straightdope.com/u/filmore)\ **Post date:** [October 13, 2017, 7:04pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1504 "2017-10-13T19:04:25Z")
> [@Bricker](#): > > In the real world, regulatory bodies for other industries respond with essentially equal alacrity to complaints from out of state. But that doesn’t mean that all regulatory bodies all act the same. It means that Delaware will view all the complaints the same, but it doesn’t mean that Delaware’s insurance board will deal with the problems the same way as Idaho’s. Idaho might fight hard for policy holders while Delaware does nothing. In that case, all the insurance companies would move to Delaware since they know that complaints can be ignored. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [October 13, 2017, 7:04pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1505 "2017-10-13T19:04:46Z")
I know it’s been said already in the thread, but I’ll repeat it. The ACA allows insurers to cross state lines. Insurers don’t want to. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 13, 2017, 7:44pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1506 "2017-10-13T19:44:21Z")
> [@jsgoddess](#): > > I know it’s been said already in the thread, but I’ll repeat it. The ACA allows insurers to cross state lines. Insurers don’t want to. There are two possible readings to this, so let me ask a clarifying question: does the ACA repeal the portion of the McCarran-Ferguson Act that allows states to forbid out-of-state insurance operations? Or to put it another way: cite the portion of the ACA you’re relying on, please. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 13, 2017, 7:45pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1507 "2017-10-13T19:45:36Z")
> [@filmore](#): > > But that doesn’t mean that all regulatory bodies all act the same. It means that Delaware will view all the complaints the same, but it doesn’t mean that Delaware’s insurance board will deal with the problems the same way as Idaho’s. Idaho might fight hard for policy holders while Delaware does nothing. In that case, all the insurance companies would move to Delaware since they know that complaints can be ignored. Can you describe any other industry that this has happened with? And if it did, can you explain why people would continue to use that company? ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 13, 2017, 7:48pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1508 "2017-10-13T19:48:10Z")
> [@k9bfriender](#): > > That is how it is now. > > “Allowing competition across state lines” would change that. If you could buy car insurance the way you would be able to buy health insurance, then you could buy policies that do not meet Maryland’s liability standards. > > It is not that the companies are not allowed to operate in different states, just as you have Allstate and State Farm in pretty much (if not all) states, you also have Blue Cross and Anthem in pretty much all (if not all) states. > > It is the policies that they offer that are regulated by the states they are sold into. That is what they want to change. Not exactly. You have Blue Cross / Blue Shield of Tennessee operating in Tennessee. And Blue Cross / Blue Shield of Illinois, a separate corporation, operating in Illinois. Can you cite a single case of a single corporation selling health insurance in multiple states? ---
**Author:** ![filmore](https://avatars.discourse-cdn.com/v4/letter/f/7993a0/32.png) [@filmore](https://boards.straightdope.com/u/filmore)\ **Post date:** [October 13, 2017, 8:03pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1509 "2017-10-13T20:03:54Z")
> [@Bricker](#): > > Can you describe any other industry that this has happened with? > > And if it did, can you explain why people would continue to use that company? I’m not an expert in this area, so I don’t have any examples. With credit cards, it’s not life-or-death if you have a complaint with them, so it’s not as critical that complaints are handled properly. As to why people would use such companies: - They may not have any choice. If all companies move to Delaware, there may not be other companies to chose from. - They may not be able to afford better insurance. Delaware companies can offer cheaper insurance since they don’t have as much regulatory oversight. They can save money by not paying claims and Delaware won’t do anything about it. - People were buying crap insurance policies before the ACA. They bought a cheap insurance policy that was hardly worth more than the premiums they paid. The difference with health insurance is that people cannot accurately gauge how much they will need until it’s too late. Anyone can be struck with a $1million dollar illness, but not everyone can afford a policy which covers that. Poor people will buy cheap policies because that’s all they can afford. So if the cheapest policies all come from Delaware, the poor people may not have any real option. ---
**Author:** ![Spectre\_of\_Pithecanthropus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/spectre_of_pithecanthropus/32/12343_2.png) [@Spectre\_of\_Pithecanthropus](https://boards.straightdope.com/u/Spectre_of_Pithecanthropus)\ **Post date:** [October 13, 2017, 8:17pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1510 "2017-10-13T20:17:17Z")
> [@k9bfriender](#): > > That is how it is now. > > “Allowing competition across state lines” would change that. If you could buy car insurance the way you would be able to buy health insurance, then you could buy policies that do not meet Maryland’s liability standards. > > It is not that the companies are not allowed to operate in different states, just as you have Allstate and State Farm in pretty much (if not all) states, you also have Blue Cross and Anthem in pretty much all (if not all) states. > > It is the policies that they offer that are regulated by the states they are sold into. That is what they want to change. But how would that help? If insurance is generally cheaper in some states, isn’t that because the business costs of providing medical treatment are also lower? ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [October 13, 2017, 8:23pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1511 "2017-10-13T20:23:05Z")
> [@Spectre\_of\_Pithecanthropus](#): > > But how would that help? If insurance is generally cheaper in some states, isn’t that because the business costs of providing medical treatment are also lower? It could be that those with higher medical costs are barred from getting coverage by either policy or cost. (High risk pools) ---
**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:** [October 13, 2017, 8:24pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1512 "2017-10-13T20:24:25Z")
> [@Bricker](#): > > There are two possible readings to this, so let me ask a clarifying question: does the ACA repeal the portion of the McCarran-Ferguson Act that allows states to forbid out-of-state insurance operations? > > Or to put it another way: cite the portion of the ACA you’re relying on, please. That’s not my understanding of McCarran-Ferguson. M-F allows states to regulate insurance in their state. States have chosen to set up their own requirements for insurance companies that operate in their state. So a company can write polices in state A who may have a a certain level of risk based capital, but B’s requirements could be higher. That’s up to each state to decide and as long as the insurer complies with the in-state requirements they can write all they want. > [@Bricker](#): > > Not exactly. You have Blue Cross / Blue Shield of Tennessee operating in Tennessee. And Blue Cross / Blue Shield of Illinois, a separate corporation, operating in Illinois. > > Can you cite a single case of a single corporation selling health insurance in multiple states? I’m not familiar with Blue Shield’s corporate structure, but having separate companies in different states isn’t indicative of a requirement existing. Separate companies allows for segregation among lines of business, easier isolation of activity for rate filings, segregation of product lines, etc. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [October 13, 2017, 9:01pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1513 "2017-10-13T21:01:05Z")
> [@Bone](#): > > …I’m not familiar with Blue Shield’s corporate structure, but having separate companies in different states isn’t indicative of a requirement existing… This is most likely a very intelligent statement. I judge that by my inability to understand it. Do you mean that the fact that a corporation does business as various separate companies is not, in itself, “indicative” that they were responding to a “requirement”? They don’t actually _have_ to, they _want_ to? ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 13, 2017, 9:32pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1514 "2017-10-13T21:32:40Z")
> [@Bricker](#): > > Not exactly. You have Blue Cross / Blue Shield of Tennessee operating in Tennessee. And Blue Cross / Blue Shield of Illinois, a separate corporation, operating in Illinois. > > Can you cite a single case of a single corporation selling health insurance in multiple states? I’m not sure how all the corporate structures work out, but are those companies not associated with blue cross? I assumed that Blue Cross was the parent company of all the blue cross of “state” companies. > [@Bricker](#): > > Can you describe any other industry that this has happened with? > > And if it did, can you explain why people would continue to use that company? There are often not all that many choices in the first place. If all the choices are the same, and all located in the same state, then you don’t have much choice in that matter. There is also the fact that many people have even less choice, as they get their insurance through their employer. The employer may like the lower premiums, and not care so much about the lower quality service. Then the employees have a choice of using “that company” or not having insurance. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 13, 2017, 9:37pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1515 "2017-10-13T21:37:44Z")
> [@Bone](#): > > That’s not my understanding of McCarran-Ferguson. M-F allows states to regulate insurance in their state. States have chosen to set up their own requirements for insurance companies that operate in their state. So a company can write polices in state A who may have a a certain level of risk based capital, but B’s requirements could be higher. That’s up to each state to decide and as long as the insurer complies with the in-state requirements they can write all they want. That’s not a complete description. States must explicitly allow inter-state insurance business – not simply set up neutral rules that apply to all companies. To pick some specific examples, since only a few states have authorized this, Georgia in 2011 did exactly what you describe: passed H. 47, which allowed insurers authorized to transact insurance in other states to issue individual accident and sickness policies in Georgia and provided for minimum standards for such policies. Rhode Island, Maine, Kentucky, and Oklahoma have done so as well (cites on request). But it’s not permitted at all in every other state. Note that I mean NOT PERMITTED, as opposed to “as long as they follow our standards.” In a few states, the legislature considered such a law but did not enact it (see, e.g., Arizona, who tried twice: 2008’s H. 2776 which died in committee and 2011’s S. 1593 which was vetoed by the governor). The strong majority of states do not have such enabling legislation, and it is thus not permitted within their borders to issue accident and sickness policies if your company is foreign – that is, out of state. The ACA’s Section 1331(b)(3)(B) permits states to enter into multi-state compacts but does not require it. In other words, states could, but right now, they generally do not permit foreign insurance sales. No matter what standards apply. Now, I have cited relevant law. I’d ask that any further posts saying, “Nuh uh!” also cite to some law upon which they are relying. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 13, 2017, 9:41pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1516 "2017-10-13T21:41:16Z")
> [@k9bfriender](#): > > I’m not sure how all the corporate structures work out, but are those companies not associated with blue cross? I assumed that Blue Cross was the parent company of all the blue cross of “state” companies. Wait, so your confident declaration about the law permits was based on seeing the same name across different companies? Are you speaking here with any actual knowledge of the legal framework? Ownership of the companies may extend to out-of-state entities, including parent companies with the same name. Risk pools do not. Overhead, fringe, and G&A costs do not. ---
**Author:** ![Clothahump](https://avatars.discourse-cdn.com/v4/letter/c/51bf81/32.png) [@Clothahump](https://boards.straightdope.com/u/Clothahump)\ **Post date:** [October 13, 2017, 9:43pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1517 "2017-10-13T21:43:08Z")
> [@ElvisL1ves](#): > > What do you expect to happen to \*your \*premiums? If I can buy across state lines, I expect them to go down. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [October 13, 2017, 9:46pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1518 "2017-10-13T21:46:00Z")
> [@Spectre\_of\_Pithecanthropus](#): > > But how would that help? If insurance is generally cheaper in some states, isn’t that because the business costs of providing medical treatment are also lower? Yes. And issuers base their pricing on what they have to do relative to the network they have in a given area. Networks are the crux. If an issuer does not have a network in an area, it’s really hard for them to go in and set one up, and they have little reason to think they are going to undercut the local issuers there. ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [October 13, 2017, 10:12pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1519 "2017-10-13T22:12:22Z")
The Republicans who want to buy across state lines remind me of car buyers who are swayed to get a more expensive car by the salesman asking “What does the payment have to be for you to sign?” Sure, they get a lower payment, but they end up with a 10 year payment schedule. When you buy insurance across state lines because it’s cheaper, you may have to put up with a lifetime cap on payments, or a situation where the only hospitals that cover you are in a different state. Get in a car accident in a major city? You may have to arrange transport to Delaware to get covered care. Even when they cover out of network costs for emergencies, they will reimburse for the state where they are located. If you end up in a metropolitan ICU where your stay costs $250K, the hospital may be reimbursed the rural West Virginia rate of $50K, and the rest of the charge will be billed to you. This already happens under the ACA but mostly affects travelers. With the new changes it will happen a lot more. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 13, 2017, 10:18pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1520 "2017-10-13T22:18:38Z")
> [@Bricker](#): > > The ACA’s Section 1331(b)(3)(B) permits states to enter into multi-state compacts but does not require it. In other words, states could, but right now, they generally do not permit foreign insurance sales. > > No matter what standards apply. > > Now, I have cited relevant law. I’d ask that any further posts saying, “Nuh uh!” also cite to some law upon which they are relying. Right, and the point is that each state gets to set its own rules as to whether or not it will allow insurance companies to sell across state lines into it. If a state wants to allow it, it can. If a state does not want to allow it, it does not have to. This takes that right away from the state to make that determination, and forces it to accept plans from out of state. > [@Bricker](#): > > Wait, so your confident declaration about the law permits was based on seeing the same name across different companies? > > Are you speaking here with any actual knowledge of the legal framework? Specific to each and every company and subsidiary, no, and I doubt that you have that level of knowledge of the insurance company either. My “confident declaration” is based on more than just seeing the same name. It’s based on seeing how they are owned by companies of the same name. As to the basics of the legal framework, sure. They are nearly all owned by a few huge parent companies that have subsidiaries in the states that they cover. This means that if they can sell across state lines, then they can shut down their individual subsidies in the different states, and sell plans directly through their parent copr, located in the state with the most lenient laws and regulations towards providers. > [@](#): > > Ownership of the companies may extend to out-of-state entities, including parent companies with the same name. Risk pools do not. Overhead, fringe, and G&A costs do not. I suppose making the risk pool larger would help some of the small states, like wyoming or north dakota. I would have no problem with those states getting together, and allowing insurance to be sold across those lines. The ACA doesn’t have a problem with it either, those states are free to open themselves up that way. So, if this was such a great idea, you would see most of the small states banded together in a single risk pool already. If there were a law that prevented states from allowing policies to cross state lines, that would be one thing, and should be looked at if the states want it. There is no such law, the law only respects the states decision as to whether or not to allow such policies. This would get rid of the rights of states to regulate the insurance products sold to their residents. [Previous page](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146.md?page=75) [Next page](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146.md?page=77)