The Repeal of Obamacare/ACA: Step-bystep, Inch-by-inch

[k9bfriender]

@Bricker

The McCarran-Ferguson Act requires a state affirmatively permit such dealings. So without any California law on the books preventing it, insurance companies from out of state can’t sell in California.

Now, you say this is simply respecting California’s rights (although claims above in the thread seemed to suggest that any company could sell anywhere as long as they met the same standards, which is not correct – a Nevada company can offer identical policies to a California one and still not legally operate in California. Do you acknowledge this?)

The problem with this is: it’s relatively unique to insurance (and a few other industries). That is, California can’t prevent me from selling furniture or vacuum cleaners even if I am an out of state company, even if they tried to pass a law doing so. This is true for the vast majority of commerce.

Why? Because of the dormant Commerce Clause.

I’m going to stop here and ask if I need to explain this further, or if you’re familiar enough with the dormant Commerce Clause that the point is clear.

While I am sure that you understand these things much better than I, I am not unfamiliar with, and did a quick refresher on the pertinent laws and clauses.

Now, of course you are correct that the DCC says that states may not regulate products from other states differently than they regulate their own. A state may have requirements that are not needed by any other state, but those requirements must be applied to in state products as well. In other words, it prevents states from engaging in trade wars with each other.

So, absent any other law, states would not be able to prevent insurance products from crossing state lines, but, there is a law, the aforementioned McCarran-Ferguson Act.

This act followed quite a number of other legislative and court actions attempting to put some sort of regulations on insurance products, as, at the time, fire insurance was the big thing to be concerned about (health insurance barely existed), and some fire insurance companies were fly by nights, they’d take your money, but when a big fire hit an area, and lots of claims came due, they’d vanish, they didn’t have the reserve to pay out the claims they had, and there was no regulation to assure that they would have reserves to pay claims. They were interstate, so could not be regulated by the states, but they were not “commerce” so could not be regulated by congress under the commerce clause.

The McFA was a compromise, that allowed insurance products to be regulated. I don’t know that regulating at the state level is superior to the fed level, but they thought so at the time, and it’s what we have now.

Do you feel that the McFA violates the commerce clause, or that it is just an unwise law? Do you think it would be better to regulate insurance at the federal, rather than at the state level? I don’t see how it can be regulated at the state level, while being sold across state lines. If the insurance is sold out of another state, then you are not the constituents of the politicians that would be regulating or investigating complaints against it. I see that as a problem.

It does seem the only viable options are to regulate it at the state level, and allow the states to determine whether they will allow products from other states to be sold in their state, or regulate it at the fed level. This having it both ways thing will return us to the problems that the McFA was put in place to solve.

[asahi]

@Merneith

Screw that. The GOP isn’t going to save Obamacare (as delicious as that would be). Forget pleading with them. Take all the energy and anger focus it on the next election.

They’re not going to save Obamacare because they’re increasingly at war with each other, which might seem like a fortunate turn of events but eventually, a winner will emerge. Steve Bannon is trying to turn the Republican party into a party of White Christian Nationalist fascists. And they could become an increasingly toxic presence in the years ahead. The Democrats might be preparing for another conventional election, but 2018 will be anything but. Bannon’s party is preparing to fight dirty. Bannon is a man at war, and he’s dangerous.

[enipla]

@asahi

They’re not going to save Obamacare because they’re increasingly at war with each other, which might seem like a fortunate turn of events but eventually, a winner will emerge. Steve Bannon is trying to turn the Republican party into a party of White Christian Nationalist fascists. And they could become an increasingly toxic presence in the years ahead. The Democrats might be preparing for another conventional election, but 2018 will be anything but. Bannon’s party is preparing to fight dirty. Bannon is a man at war, and he’s dangerous.

Turn them INTO White Christian Nationalist fascists? We are already there. And they are already fighting dirty by using foreign money and influence to swing our elections.

Mueller?
Mueller?

[Bricker]

@k9bfriender

While I am sure that you understand these things much better than I, I am not unfamiliar with, and did a quick refresher on the pertinent laws and clauses.
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The McFA was a compromise, that allowed insurance products to be regulated. I don’t know that regulating at the state level is superior to the fed level, but they thought so at the time, and it’s what we have now.

Correct.

There were a number of comments above that strongly suggested that interstate insurance sales was available now, without any legislation needed. Your summary above seems to indicate you now understand that to be false: that apart from a few states, there is no enabling state legislation in place to permit that.

For example, in post 1501, you said:

@k9bfriender

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.

This post didn’t seem to acknowledge that it IS that the companies are not allowed to operate in different states; in fact, it explicitly says the opposite.

Do you feel that the McFA violates the commerce clause, or that it is just an unwise law?

No violation! It’s federal law, and the ACTUAL commerce clause clearly grants Congress the power to regulate interstate commerce.

I think that it’s unwise, however on point it might have once been for shady fire insurance companies.

Do you think it would be better to regulate insurance at the federal, rather than at the state level? I don’t see how it can be regulated at the state level, while being sold across state lines. If the insurance is sold out of another state, then you are not the constituents of the politicians that would be regulating or investigating complaints against it. I see that as a problem.

I think the wise course would be for the feds to set minimum standards and permit states to depart upwards.

It does seem the only viable options are to regulate it at the state level, and allow the states to determine whether they will allow products from other states to be sold in their state, or regulate it at the fed level. This having it both ways thing will return us to the problems that the McFA was put in place to solve.

No, because we have a communication and data exchange infrastructure that did not exist in the 1940s.

[fervour]

@Bricker

Correct.

. . . .
This post didn’t seem to acknowledge that it IS that the companies are not allowed to operate in different states; in fact, it explicitly says the opposite. . . .

There was also my post explaining that the various BC/BSs clearly have some sort of reciprocal agreements. My guess is you know this. My guess is that you know that your health insurance policy covers you if you leave Virginia.

Pretending that coverage is a mish-mash of unexplored thought is fearmongering.

I don’t suspect the idea from conservatives is to ease minds but provide confusion.

Of course I realize who provides insurance may be seperate from the provider of the service. They can be in differerent states. And that can have a lot or a little to do with what the insured paid. The big insurance companies have reciprocal agreements with the various state/plans. The small companies do not. Not everyone with republican health insurance is going to pay $300 for a broken wrist. A shitty republican party plan might require $20k to $40k for that broken wrist. Interstate agreeements matter. And so company matters

I don’t think you have addressed how my broke wrist, broken in Philadelphia, PA, can be handled by PA for $300 paid by me and whatever by BC/BS AL/ The big insurance companinges willl have worked out the RATES

[Bricker]

@fervour

There was also my post explaining that the various BC/BSs clearly have some sort of reciprocal agreements. My guess is you know this. My guess is that you know that your health insurance policy covers you if you leave Virginia.

Pretending that coverage is a mish-mash of unexplored thought is fearmongering.

I don’t suspect the idea from conservatives is to ease minds but provide confusion.

Of course I realize who provides insurance may be seperate from the provider of the service. They can be in differerent states. And that can have a lot or a little to do with what the insured paid. The big insurance companies have reciprocal agreements with the various state/plans. The small companies do not. Not everyone with republican health insurance is going to pay $300 for a broken wrist. A shitty republican party plan might require $20k to $40k for that broken wrist. Interstate agreeements matter. And so company matters

I don’t think you have addressed how my broke wrist, broken in Philadelphia, PA, can be handled by PA for $300 paid by me and whatever by BC/BS AL/ The big insurance companinges willl have worked out the RATES

I suspect that some plans treat it as out-of-network, emergency care, even if they pay for it. I have no idea how your plan treated it. Who cares? Why do you think this is a relevant question? The issue is the size and health of the available risk pool, and that is what determines rates. How in heaven’s name does your wrist address that?

[BigT]

So Bricker’s is nitpicking needlessly again. They can stop insurance in a state if they don’t comply with the laws of that state. That’s the same thing as saying they have to comply with the regulations in that state.

Personally, if we had proper regulations at the national level, I wouldn’t mind. But having a national requirement that you accept insurance from all other states without a national limit on what that would be just means all insurance sets up in the most permissive state, and one state controls all the other states. The voters in that state get control on insurance in every other state. That’s not a desirable outcome.

Normally states rights suck. But, in this case, absent the federal government regulating it, state’s rights is the best we have. Reducing state’s rights without increasing federal rights just means getting rid of rights altogether. That is bad.

[k9bfriender]

@Bricker

Correct.

There were a number of comments above that strongly suggested that interstate insurance sales was available now, without any legislation needed. Your summary above seems to indicate you now understand that to be false: that apart from a few states, there is no enabling state legislation in place to permit that.

For example, in post 1501, you said:

This post didn’t seem to acknowledge that it IS that the companies are not allowed to operate in different states; in fact, it explicitly says the opposite.

I’ll acknowledge to sloppy wording, in that I said that there was a blue cross et al. in each state, but did not state that there was there was a subsidiary of blue cross et. al. in every state. I did not see how it made a difference, so did not make the distinction.

I still don’t really see how it makes a difference, but I am more than willing to acknowledge the distinction.

The only thing that I see that it makes any difference at all is the risk pools, and most states are more than big enough to get a sufficiently large risk pool that a larger one won’t really make a difference. The few states that do not have a large enough population to act as a sufficient risk pool (mostly conservative states) have the option to pass legislation to allow insurers to cross into their state.
No violation! It’s federal law, and the ACTUAL commerce clause clearly grants Congress the power to regulate interstate commerce.

[/quote]

Just asking where your opinion settled on the matter, as at the time, there was some question as to whether congress could do that, as insurance products were not considered commerce.

I think that it’s unwise, however on point it might have once been for shady fire insurance companies.

Would it be more acceptable if it only gave the states the option to prevent insurance from being sold into their state, without setting that as the default?

Instead of requiring an affirmative action from the state to be able to but across the lines, it would require an affirmative action to prohibit that. Remember, without McFA, the states would not be allowed to create such a law.

I think the wise course would be for the feds to set minimum standards and permit states to depart upwards.
No, because we have a communication and data exchange infrastructure that did not exist in the 1940s.

The question is, is who is doing the regulation and who is responding to complaints. If the governing body that is enforcing regulations is not made of people I can influence by my vote, then we have a problem.

You say the fed should set minimum standards, but who are you putting in charge of enforcing those standards, the fed, or the state in which the insurance company is incorporated. If the fed, well, the fed is always unwieldy, and there are reasons why some stuff is actually better done by the states, but it would not be unreasonable for that to work out. If it is enforced by the state in which it is incorporated, then I , as an Ohioan, do not have any influence over the enforcement of a product that I may have no choice but to buy from delaware.

[jasg]

Putting aside the legality of cross-state insurance sales or regulation… The question that never seems to get asked or answered is “Why would insurers want to sell health insurance across state lines?”.

Healthcare costs are extremely local - for example, the GP in my home town of 2000 in rural Pennsylvania charges less than a city GP. Combine that with the fact that each provider hospital, physician group and so on negotiates prices with each insurer they accept.

Is every provider going to negotiate with every insurer and vice versa? Seems unlikely, so I guess everything is out of network.

Here is a good analysis of the issue.

[Guest-starring_Id]

It looks like California and 17 other states filed a lawsuit Friday challenging the Trump administration’s decision to roll back cost-sharing subsidies that help reduce the price of healthcare for millions of Americans.

The legal challenge says the subsidies are lawful, that the Trump administration action conflicts with federal law and that the president failed to follow proper procedure to change the subsidies that benefit 6 million people, including 700,000 Californians.

No idea how much traction this is going to have, whether it’s just tilting at windmills, or if it will carry the same import as with the Hawaiian and Maryland federal judges’ rulings last March.

[ThelmaLou]

@Guest-starring_Id

It looks like California and 17 other states filed a lawsuit Friday challenging the Trump administration’s decision to roll back cost-sharing subsidies that help reduce the price of healthcare for millions of Americans.

No idea how much traction this is going to have, whether it’s just tilting at windmills, or if it will carry the same import as with the Hawaiian and Maryland federal judges’ rulings last March.

If it gets to the Supreme Court, I wonder which way it would go? :rolleyes:

[Bricker]

@k9bfriender

The question is, is who is doing the regulation and who is responding to complaints. If the governing body that is enforcing regulations is not made of people I can influence by my vote, then we have a problem.

Just this week the Ninth Circuit handed down Nationwide Biweekly Administration v. Owen.

Ms. Owen is the Commissioner of the Department of Business Oversight in California, and Nationwide Biweekly is an Ohio corporation aggrieved over California’s attempt to require that it incorporate in California in order to do business there.

The appeals court said, in essence, “Tough titties, California, the Dormant Commerce Clause says it sucks to be you.” Nationwide does not have to incorporate in California just to do business there.

The panel held that this form of discrimination between in-state and out-of-state economic interests was incompatible with a functioning national economy, and the prospect of each corporation being required to create a subsidiary in each state was precisely the sort of “Balkanization” that the Dormant Commerce Clause exists to prevent.

But they don’t sell health insurance.

[wonky]

The Alexander-Murray plan that is coming into focus looks like it can be very good for both sides. I’m optimistic for the first time this year.

[elucidator]

Oh, you poor dear! I got here too late!

[wonky]

@elucidator

Oh, you poor dear! I got here too late!

snerk

Well, it won’t last, I guarantee.

BTW, the language is likely to require regulatory language on interstate compacts. It’s still all about the networks, though, so don’t expect this to do anything.

[k9bfriender]

@Bricker

Just this week the Ninth Circuit handed down Nationwide Biweekly Administration v. Owen.

Ms. Owen is the Commissioner of the Department of Business Oversight in California, and Nationwide Biweekly is an Ohio corporation aggrieved over California’s attempt to require that it incorporate in California in order to do business there.

The appeals court said, in essence, “Tough titties, California, the Dormant Commerce Clause says it sucks to be you.” Nationwide does not have to incorporate in California just to do business there.

But they don’t sell health insurance.

I’d never heard of them before, and now that I have, that looks like a pretty scammy company, if reviews and BBB reports are to believed, I am not sure that reducing the amount of oversight and regulation on it is actually in anyone’s best interest but that companies investors. What recourse does someone in california have if they get screwed by this company? Can they take it up through the california AG, or would they need to contact and get Ohio’s AG on board before they could get anything done?

But, they do sell life and mortgage insurance. These are a bit different than life or fire. If nothing else, those insurances are not nearly as necessary as health or fire insurance.

[Elendil_s_Heir]

The President strongly supports the bipartisan Senate healthcare reform bill… until he doesn’t: http://www.cnn.com/2017/10/18/politics/health-care-state-of-play/index.html

[jasg]

I love the way the President and Ryan refer to the Alexander/Murray proposal as a “bailout for insurance companies.”

So instead, the insurance companies will raise premiums on customers and the government will pay more in subsidies.

Insurance companies Win!!! Customers and Taxpayers lose… (along with hospitals and providers who will have fewer paying clients)

Ya gotta love free market healthcare.

[jasg]

Vox has a clever explanation of the effects of the executive order.

[wonky]

ACA open enrollment starts tomorrow. I wanted to flag it since there’s a ton of confusion out there. If you get credits, you may find that it’s more affordable than last year, so be sure to shop, including all metal tiers and looking at all out of pocket expenses and cost sharing.