Posted on 03/07/2019 5:45:23 AM PST by DoodleDawg
Remember when President Trump campaigned on a health care platform of eliminating "the lines around the states?" Well, that particular white whale has re-emerged.
Driving the news: The Trump administration posted a 15-page document Wednesday asking for public comment on a range of questions related to the interstate sale of health insurance — including questions about using part of the Affordable Care Act to make that change.
How it works: Critics see this as a backdoor way to deregulate insurance. If a patient in New York can buy a lightly regulated policy from Iowa, what good are New York's rules about what plans have to cover and how they have to cover it?
There are logistical hurdles: It's pretty hard to set up a network of doctors and hospitals that will work for patients in both Iowa and New York.
Between the lines: The administration already took a bit of a victory lap on this front when it expanded access to association health plans.
That wasn't a full-scale deregulation, but it did expand of a type of insurance that can cross state lines — even though, due to the difficulty of creating provider networks, those plans are generally confined to one metro area.
With slight variations.
Do you know how many experiments Thomas Edison had to do before he came up with a working light bulb?
Tell me how to convince a business to enter into a transaction that they are guaranteed to lose money on and you have solved the problem with interstate sale of health insurance. Hopefully that won't take too many experiments for you.
The insurance companies are already doing this. The existing state-by-state requirements probably cost them more in added infrastructure to operate the "in-state" process across multiple states.
Deregulate and let those who want to organize multi-state do so.
You miss the point...these companies already have such networks set up, plus the need for the extra local bureaucratic infrastructure to manage multiple in-state systems. Going interstate will probably be cheaper than their existing structure.
Just as you do with a credit card.
Yes. Insurance should be admittedly “Interstate Commerce”.000
Employees everywhere are working for employers with multi-state presence with shifting of employees between those different locations. Individuals can also be residents of one state and working in a next-door state. Besides, a truly free national market place theoretically does mean the ability to buy insurance from an insurer that is anywhere in the country, and that insurer not needing 50 different sets of “regulations” they have to comply with.
Insurers should be able to apply for a “national charter” that puts them under one set of regulations and allows them to cross state lines.
I would not house that regulating body inside the federal government.
I would convene representatives of the 50 state insurance boards, and the insurers operating in the states, to hash out one set of nationwide rules on health insurance, achieved by majority votes of both the state regulators and insurers - independently, and not needing 100% agreed on consensus either way.
The regulator whose rules they would be writing would be a non-governmental body that insurers can voluntarily choose to be regulated by, instead of the states. A federal law or regulation would protect them for making that arrangement. Annually, the state insurance boards & the insurers could jointly review the rules they have agreed to for the multi-state regulator. Insurers fees paid to the multi-state regulator would pay for its minimal needed operations. That fee method could also be used for funding the establishment of the single national “market exchange” the insurers and insurance consumers can communicate, regarding the signing up for and cancellation of an insurance policy.
Ergo - no new federal government tax supported bureaucracy for the political class to argue over funding.
Absolutely. Also larger pools mean lower premiums.
If it’s a matter of state “regulations and mandatory” items that every insurance plan must meet, then the problem is not with the insurance companies per se, or the insurance agent.
We are always faced with the back room deals made between insurance companies and elected officials, or worse yet, some nameless, unelected civil “servant!”
Force states to list each mandated item and it’s cost, like we are now doing with fat and caloric values on restaurants.
It’s high time for consumers to know each and every cost add on, like other consumer goods.
Let the customer decide!
Give an example of when and where it failed?
“I agree with you absolutely. You can go to a state like Alabama and find all kinds of insiders/lobbyists who are milking the state system, to ensure x-policies cost this much, and that the state commission avoids asking loaded questions.
Imagine having a state by state milk system, and that a gallon of milk in Tennessee cost $1.25, and in Kentucky, it’d be $0.94. You’d eventually wise up and buy the product in Kentucky.”
This is exactly the issue. And the reason it didn’t work before was because they didn’t do it right. They are protecting “demographic territories” to control pricing in certain areas and eliminate any competition against those pricing ranges for certain areas. Even national companies are involved in this scam. They are all maintaining a pricing minimum for particular states or areas. It’s “price fixing”.
Just look at auto insurance... The first question is “what’s your zip code?” because price quotes no matter who you call are going to be within a few dollars of each other for that “territory”. But it might be half as much if the same coverage was offered in another state in similar demographics. Health insurance is the same way.
It’s a scam just like business dealer and franchise “territories” that keep the pricing high, Just like the Snapon tool dealers. And if someone from another state and territory was allowed to offer lower rates in that same area they would all have to come down to compete for that same territory.
//////// Give an example of when and where it failed?
Yes, please.
In the states where they operate and have a large base of subscribers.
I'm not opposed to letting insurers try but the economic reality is if they can't offer the provider a large number of subscribers they won't get a competitive rate.
I’ve seen estimates that allowing interstate insurance sales might result in a 5% reduction in premiums, at most.
I’ll take it. Competition drives prices down. The best products rise in sales and the highly regulated (I read that as kickbacks for politicians)will sink like a stone.
If Walmart can charge the exact same price for a product nationwide no matter what city or state it’s in so can insurance companies. lol
They are scamming everyone into thinking it costs twice as much to do business in one area as another when ALL the approvals come from one central corporate source in one state.
The highest rate is going to get you the same denial of claim as the lowest rate no matter where you happen to be. You are just being forced to pay more for that same denial depending on state.
If a company does not currently do business in California or Florida then why would they go to the expense of setting up a provider network for a handful of customers?
The most they can that the locals can afford.
Someone that wants to shave a few points does so planning on the increased traffic offsetting the lower price.
Insurance is the REASON health care costs are what they are.
The insurance company guarantees the health care provider a large bag of money for their services, the health care provider charges astronomical fees to dissuade all but the most well off from paying their way out of pocket, and both the insurance and health care providers enjoy a higher standard of living.
Nice scam.
The state-specific requirements add some cost but the real cost is in negotiating with and managing a network of providers and in marketing and customer service.
The big providers, United, Anthem, Aetna, etc., have already consolidated their back office operations nationwide (e.g. IT, accounting, claims processing) so entering a new state is pretty easy - just come up with the provider network, marketing and support infrastructure - which they would have to do even if there was no regulation.
What keeps the big players out of a given state is their business decision that they won't make enough money there, and it isn't because of regulation.
You are right on the money. And if the market swings towards a new company who is more affordable, then those who accept or deny the insurance providers will have to follow if they want any business. Cause and effect.
Just deregulate it... To regulate ANY commerce over state lines is unconstitutional and it needs to be ruled on as such.
Agreed, and there are two simple ways to increase competitiveness in health care industry:
1. Prohibit health care providers and health insurers from colluding as to pricing. Most if not all provider/insurer contracts prohibit the provider from charging the consumer less than the insurer would pay to the provider for the same services. For example, suppose I decide to go out-of-network to see a highly regarded specialist/provider and offer to pay the specialist cash for the medical services. By contract with the health insurers, the provider cannot charge the patient less for the medical services than the provider would receive from the insurer for providing the same service under the health insurance plan. This smells seems like collusion and price fixing, and is probably illegal in any other consumer market.
2. Increase transparency for all medical services by posting the price prior to delivery of the service, including the book price for the service, the price charged to the insurer, and the charge to the patient, if any, in the form of deductibles and co-pays. For example, if I have to have an MRI and I have a $2,500 deductible, I ought to be able to shop for the lowest cost MRI, but I can't effectively do that because the medical care industry lacks transparency in pricing.
“I don’t. Just keep in mind that “freedom” also means you’d have to be prepared to be ripped off, too.” Alberta’s Child
Sounds like left-wing bullshit to me. I don’t need a bureaucrat or politician to protect me from being ripped off. Deregulate the health insurance market and allow sales across state lines. Allow the consumer to make their own decisions on how much coverage they need.
“I don’t. Just keep in mind that “freedom” also means you’d have to be prepared to be ripped off, too.” Alberta’s Child
Sounds like left-wing bullshit to me. I don’t need a bureaucrat or politician to protect me from being ripped off. Deregulate the health insurance market and allow sales across state lines. Allow the consumer to make their own decisions on how much coverage they need.
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