Federal Judge Strikes Down Part of Obamacare Law

[WhoWee]

Was your complaint not specifically that "every state currently has it's own rules" ?

Indeed. That's exactly the aim here.

Let me start by disclosing that I work with these rules on a daily basis. Further, IMO, Medicare and the CMS should not be the models for moving forward.

With the exchange plan, we have an opportunity to streamline and simplify insurance regulation. This is an opportunity to shrink government and bureaucracy AND reduce legal, administrative, and operating expenses at the carrier level.

However, if all 50 states design their own custom exchange (in addition to their existing 50 departments of insurance) - it will further complicate administration and compliance. It will also expand the size of Government and increase legal, administrative, and operating expenses at the carrier level.

 

[mheslep]

... first step toward allowing plans to be sold in other states' exchanges, should states wish to allow that (although it's worth noting that certain multi-state plans will be offered in exchanges immediately). ...

Visibly the states never have for health care in modern times. How are you able to now say that they will, with no certain rule in place in PPACA that allows individuals to go buy care across state lines as is granted in Patient's Health?

 

[mheslep]

I'm not sure what you're referring to with Patient's Health, but going back to Ryan's Patients' Choice Act, note that it doesn't allow blanket interstate purchasing (à la the Shadegg bill or the repeal-and-replace law). The only bit related to interstate purchasing in it concerns the exchanges:

(g) Regional Options-

(1) INTERSTATE COMPACTS- Two or more States that establish a State Exchange may enter into interstate compacts providing for the regulations of health insurance coverage offered within such States.
(2) MODEL LEGISLATION- States adopting model legislation as developed by the National Association of Insurance Commissioners shall be eligible to enter into an interstate compact as provided for in this section.
(3) MULTI-STATE POOLING ARRANGEMENTS- State Exchanges may implement a multi-state health care coverage pooling arrangement under this title.​

If you've read the ACA, this concept should look very familiar.

Yes ...Choice Act, but despite that reference I was actually thinking about the more recent proposal from Ryan here:

Interstate Purchasing. Currently, individuals and families can purchase health insurance only in the States in which they live, because insurance companies are prohibited from selling polices outside their respective States. Thus the consumer is prevented from purchasing coverage from another State that might offer more suitable, or more affordable, coverage.

This proposal breaks the lock, allowing each individual to use the refundable tax credit toward the purchase of health insurance in any State. This will greatly expand the choices of coverage available to the consumer, and also will encourage broader competition and diversity among insurers, who will be able to sell their policies to individuals and families in every State, as other companies do in other sectors of the economy. After analyzing Federal Employee Health Benefits Program [FEHBP] preferred provider organization [PPO] prices, the Government Accountability Office reports: “We found that FEHBP PPO hospital prices differed by 259 percent and physician prices differed by about 100 percent across metropolitan areas in the United States, after we removed the geographic variation associated with the costs of doing business such as rents and salaries, and differences in the types of services provided.”

Allowing consumers to shop across State lines will balance State regulation of health insurance. Individuals no longer will have to pay for health benefits mandated by their home States that they do not need; they will be able to choose policies from States whose mandates better fit their personal circumstances. States will then have an incentive to balance their insurance mandates against costs to remain competitive with other States.

http://www.roadmap.republicans.budget.house.gov/plan/#Healthsecurity

 

[Al68]

This is a bit bewildering. It sounds like you're arguing for simplification and standardization of insurance market rules, which at the very least would require a base, uniform federal standard.

I don't want to speak for WhoWee, but the biggest obstacle to a free market caused by state regulations is not just that each state has different regs, but that citizens are not free to buy "out of state" insurance. Lifting that prohibition would end the necessity of each insurer having 50 different sets of regs to comply with, but would require no uniformity among state regs, or any federal standard. Each citizen could buy insurance from whichever state, and whichever company, he determined offered the best type of policy for him.

 

[WhoWee]

There's a trade-off that has to be made. Opting for complete standardization and centralization instead of granting states more autonomy would be attacked as a federal power grab, with bureaucrats in Washington ignoring the boots on the ground in the states who understand local conditions and needs. Granted, the exchanges that were authorized in the ACA often don't get credit for what they are anyway, but I think the benefits of this structure can outweigh the drawbacks, if they're implemented with the intent of achieving various health policy goals pursued by the states. After the last election, in many states that's far from certain.

I think you've touched on the heart of the issue. The Federal Government already controls every aspect of health care (as I've explained in earlier posts). The individual states control insurance regulations - which restricts trade and increases costs. The Feds don't want to unravel/untangle the "mess" at the state level - because it will look like a power grab.

I agree, the boots on the ground - the people most familiar with the problems are (IMO - once again) ignored.

 

[SW VandeCarr]

I don't think this can be compared to auto insurance. I can opt out of car insurance, I just won't be able to drive. The government can't require us to insure our bodies. That's a bit much.

I predict that in the future we will be required to get a license to operate our bodies.

 

[nismaratwork]

I predict that this Wednesday's vote to repeal the bill has been suspended already. Oh well, maybe next time someone won't snap in the reddest state on earth.

 

[WhoWee]

Here's a little update on health care reform progress. I think we can all agree the insurance industry has been portrayed as the bad guys - correct?

Also, I've disclosed in nearly every thread on the topic that I'm professionally active in the insurance industry.

Accordingly, (I can't post specific carrier information) effective January 1, 2011 - several carriers have issued pay cuts of up to 50% to their career agents. That is, the commission-only sales force was notified that compensation for new business would be paid at a much lower rate. One example was for direct appointment reductions from 20% to 10% on health insurance products - other sub-agent agreements have comparable cuts.

Again, these agents work on a commission only basis and work very hard to build a book of business.

But who knows, if this strategy works, perhaps the same formula can be applied to Government workers - a 50% reduction of pay (and benefits - they have them - insurance agents typically don't) could lessen the deficit.

 

[nismaratwork]

Here's a little update on health care reform progress. I think we can all agree the insurance industry has been portrayed as the bad guys - correct?

Also, I've disclosed in nearly every thread on the topic that I'm professionally active in the insurance industry.

Accordingly, (I can't post specific carrier information) effective January 1, 2011 - several carriers have issued pay cuts of up to 50% to their career agents. That is, the commission-only sales force was notified that compensation for new business would be paid at a much lower rate. One example was for direct appointment reductions from 20% to 10% on health insurance products - other sub-agent agreements have comparable cuts.

Again, these agents work on a commission only basis and work very hard to build a book of business.

But who knows, if this strategy works, perhaps the same formula can be applied to Government workers - a 50% reduction of pay (and benefits - they have them - insurance agents typically don't) could lessen the deficit.

Whaaaaat? I don't think people hate insurance AGENTS... it's the system as a whole, the costs imposed, and profits made by the corporation as a whole. I imagine that salaries and benefits for the people selling plans probably is about the same as any job, and cutting it seems cruel and without any benefit except to those people who the public DOES hate; the C class execs, and other upper management, and major investors who get concentrated profit. After all, it's hard to blame TONS of faceless investors within the 401K range of investment.

btw, I didn't know that you worked in insurance. You have my condolences.

 

[WhoWee]

btw, I didn't know that you worked in insurance. You have my condolences.

I wear many hats.

The trend I see (with respect to insurance agents) is towards a less educated, lower paid, higher turnover, telemarketing format. This model requires people call in and be enrolled by a faceless person who can't possibly gauge the individual needs nor tailor solutions that fit their clients in both the short and long term.

Assuming healthcare reform fixes ALL of the problems in the under age and Medicare eligible categories - greatest concern is Long Term Care. Medicare does not address the needs of person beyond the first 100 days in a skilled nursing facility. Needless to say, long term nursing home care care is expensive and most people have no protection - many sign over their homes and go on Medicaid - another problem surely.

 

[nismaratwork]

I wear many hats.

The trend I see (with respect to insurance agents) is towards a less educated, lower paid, higher turnover, telemarketing format. This model requires people call in and be enrolled by a faceless person who can't possibly gauge the individual needs nor tailor solutions that fit their clients in both the short and long term.

Assuming healthcare reform fixes ALL of the problems in the under age and Medicare eligible categories - greatest concern is Long Term Care. Medicare does not address the needs of person beyond the first 100 days in a skilled nursing facility. Needless to say, long term nursing home care care is expensive and most people have no protection - many sign over their homes and go on Medicaid - another problem surely.

That's a disturbing trend... I can't see how under-educated employees will pay off for the consumer (not that such is the point). I'm sorry that your industry is changing in such an unfortunate way, and I know exactly what you mean about the lack of skilled nursing, the involvement required for nursing care, and frankly... just plain old NURSES. We are in trouble, whatever the cause (we don't need to agree), we can agree that trouble is-ah-comin'

 

[WhoWee]

That's a disturbing trend... I can't see how under-educated employees will pay off for the consumer (not that such is the point).

Have you ever called 1-800-Medicare and asked a specific question?

 

[nismaratwork]

Have you ever called 1-800-Medicare and asked a specific question?

Yes... I've also been hit in the head with a car's trunk. Very similar in a kind of ephemeral, but lasting way.

 

[WhoWee]

Yes... I've also been hit in the head with a car's trunk. Very similar in a kind of ephemeral, but lasting way.