"Allow insurance to be sold across state lines." Oops, we did that too.

[Schema Thing]

"Allow insurance to be sold across state lines."


That seems to be fully one half of the GOP position on fixing America's healthcare issues; the other half being of course "tort reform tort reform tort reform tort reform na na, na na nyah!".


But it looks to me like the ACA not only enables insurance to be "sold across state lines", but in fact requires it starting in 2014: from KFF.org:

Multi-State Health Plans_

Requires the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.

[ForgoTheConsequence]

1. Insurance has always been sold across state lines.

In fact there was NO federal law banning the sale of insurance across state lines. The reason it couldn't be sold across state lines in most cases is because states made up their own rules and laws regarding insurance coverage.

Any Republican still spewing this bullshit needs to be corrected, and for a party all about states rights they were pretty quick to sell out "STATES RIGHTS" when it came to giving insurance companies more of what they wanted.

[PoliticAverse]

4. The McCarran Ferguson Act (1945) allows each state to have different rules...

making it very difficult for a single company to sell the identical policy in multiple states...

http://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act

[banned from Kos]

8. "identical" policy - no big deal.

Take Texas. They have little in the way of junk add ons (ie, chiropractic and acupuncture) and there are still 25% uninsured there AFTER tort reform.

The GOP have no solutions.

[ForgoTheConsequence]

9. That was my point.

Seems like Republicans should be in favor of each state being able to make their own rules, states rights and all.....



That being said I have a Nebraska based policy and I live in Iowa. There is no Federal law keeping states and insurance companies from cooperating (as implied by the Republicans), the only thing getting in the way is the states themselves.

[Honeycombe8]

21. It's clear that there is some law prohibiting sale of ins across state lines.

Maybe it's a state thing, where some states prohibit it, and there is no federal law allowing it. So the state's law is controlling, there being no conflicting federal law?

I'm in TX and as far as I know, I can't go online and shop for ins. plans offered in Nebraska or any other state.

[mercuryblues]

2. That is why

it is constitutional. Congress has the authority to regulate trade between states.

[SickOfTheOnePct]

6. It was found unconstitutional under the Commerce clause n/t

[PoliticAverse]

3. Articles on the 'insurance across state lines issue...

NPR article (from 2009): http://www.npr.org/templates/story/story.php?storyId=120276553

Recent Forbes article: http://www.forbes.com/sites/aroy/2012/05/11/will-buying-health-insurance-across-state-lines-reduce-costs/

NCSL background article: http://www.ncsl.org/issues-research/health/out-of-state-health-insurance-allowing-the-purch.aspx

[SickOfTheOnePct]

5. If it's referencing OPM, then it most likely applies to insurance for government employees n/t

[Schema Thing]

7. no, it's referring to the insurance exchanges in each state.

[SickOfTheOnePct]

11. Could you please provide a link to your source?

I went to kff.org, but didn't see the section you quoted. I've never heard anything about OPM being involved in state insurance exchanges.

[SickOfTheOnePct]

12. Never mind, I found it

http://www.ebglaw.com/showclientalert.aspx?Show=14556

The OPM is contracting for multi-state plans (you learn something new every day), but the plans must be sold by companies licensed in each state, and must conform to state law.

So not really selling across state lines.

[ProSense]

13. Here's some information:

OPM details plans to offer health coverage to uninsured Americans

The Office of Personnel Management plans to sign contracts with at least two health care insurers in fiscal 2013 to provide coverage to millions of uninsured Americans.

OPM said in its fiscal 2013 budget justification, released Feb. 17, that its role in the Obama administration's massive health care overhaul will kick in next fiscal year. The Affordable Care Act requires OPM to set up multi-state plans on so-called "affordable insurance exchanges."

OPM said it will sign the contracts for the plans by September 2013. The exchanges will be created in October 2013, and will start covering uninsured people in January 2014.

<...>

The multi-state plans will be run similarly to the government's Federal Employees Health Benefits Program. It will be the first time OPM will administer a health care plan for people other than federal employees, retirees or their families.

- more -

http://www.federaltimes.com/article/20120220/PERSONNEL01/202200303/OPM-details-plans-offer-health-coverage-uninsured-Americans

Here's a more detailed analysis:

<...>

Who has oversight for MSPs in the exchanges?

The OPM Director will contract with health insurance companies to offer MSP individual coverage and group coverage for small employers in exchanges for a one-year maximum term. This is different from the arrangements for other QHPs, which will contract directly with states. The MSP contracts will be automatically renewable for additional one-year terms. This approach is modeled on how OPM administers nationally available FEHBP plans.

MSPs must be licensed in each state and meet other state requirements similar to the intrastate QHPs, but it is the OPM Director that has general oversight of the MSPs. OPM will negotiate premiums, set profit margins, medical loss ratios, and other coverage terms with insurers and can prohibit them from offering plans that do not meet these terms. This is important because these are functions that states will carry out for other QHPs. OPM may go beyond state regulations to establish more rigorous review than states and to more actively pursue value-based purchasing or payment reform strategies, for example.

In addition, CMS has recently released rules6 governing state exchanges which further clarify that OPM will determine if MSPs meet all QHP standards and will certify, recertify, and decertify MSPs.7 OPM also will determine rates, transparency reporting, accreditation timelines and network adequacy standards for MSPs. In addition to exemption from state certification procedures for QHPs, MSPs are exempt from Exchange processes for receiving and considering rate increase justifications and for Exchange processes for receiving annual rate and benefit information.

- more -

http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_A80A0AAA-5056-9D20-3D25B59C65680B79.pdf

[Ruby the Liberal]

14. I may have missed it,

but do you know if the OPM component of the exchanges is designed to be in every exchange, or just those states that either forego their own exchange (or choose the federal collaboration option)?

IOW - if a state sets up their own exchange (or adds a single payer like Vermont is looking into), will OPM not be an option for them?

[ProSense]

15. Every state, but

...do you know if the OPM component of the exchanges is designed to be in every exchange, or just those states that either forego their own exchange (or choose the federal collaboration option)?

IOW - if a state sets up their own exchange (or adds a single payer like Vermont is looking into), will OPM not be an option for them?

...moving to single payer involves a waiver.

[Ruby the Liberal]

17. Waiver?

I am not in Vermont, so only marginally familiar with what they are doing (ie, I heard they are looking at Single Payer).

Does this then mean OPM will be available in each state exchange except those like Vermont AND that Vermont won't be setting up an exchange - only offering a single state option in its place?

[ProSense]

19. Yes, waiver:

FACT SHEET

"State Leadership in Healthcare Act‟

Section 1332 of the Patient Protection and Affordable Care Act – the “Waiver for State Innovation” – allows states to waiver out of some of the requirement of federal health reform if they meet certain standards. The provision in the new law was authored by Sens. Bernie Sanders (I-Vt.) and strongly supported by Sen. Patrick Leahy (D-Vt.) and Rep. Peter Welch (D-Vt.).

The Sanders-Leahy-Welch “State Leadership in Healthcare Act” moves the availability of state waivers from 2017 to 2014. This would allow a state to avoid the expense of setting up an exchange – which is otherwise required in every state in 2014 – only to dismantle it later.

The federal waiver would allow a state to:

a) Collect all the federal funding and use for financing coverage for individuals through a plan designed by and for that state.
b) Coordinates this waiver process with Medicare, Medicaid and CHIP waiver processes that may be required depending on the design of the system. The state

The federal waiver would not allow a state to:

a) Offer lower quality or less affordable care to their residents than would be available in the exchange.
b) Obtain waivers from the health insurance market reforms implemented under the law such as those benefiting ending the use of pre-existing conditions to exclude individuals from coverage or those allowing young adults to stay on their parents’ plans longer.

How does the waiver provision of the law work?
Step 1: The state passes a law to provide health insurance to its citizens.
Step 2: The Secretary of Health and Human Services and Secretary of the Treasury review the state law and determine that the plan is:

a) At least as comprehensive as its residents would receive in the exchange;
b) At least as affordable;
c) Deficit neutral to the federal government; and,
d) Covers at least as many people.

Step 3: If the federal government finds that the alternative state system meets these requirements without certain federal rules, states can get a waiver. The state plan could receive waivers from:

a) The section requiring establishment of the exchange
b) The designs for how federal subsidies would have to reduce premiums and co-pays.
c) The employer penalty for providing coverage
d) The individual mandate.

http://www.sanders.senate.gov/graphics/011411state_waiver_fact_sheet.pdf

The Affordable Care Act: Supporting State Innovation
http://www.healthcare.gov/news/factsheets/2012/02/state-innovation02222012a.html

[Ruby the Liberal]

20. Very interesting!

I missed all of that. Given the cost saving model of Medicare, I am surprised more states aren't looking to take this approach.

Thanks!!!

[FarCenter]

10. Due to state regulations, insurance companies set up separate subsidiaries in each state.

The state X subsidiary won't sell insurance to a state Y resident.

[underpants]

16. The reason for state-by-state plans is because the process would be corrupted by the industry

if we allowed plans to be across state lines the insurance companies would OFFICIALLY be located in the Northern Marianis Islands or Delaware (like credit card companies) or in some state that gave them extreme liability limits and huge corporate tax breaks. They are like water, or blood, or cancer, they will flow where ever they can.

[Ruby the Liberal]

18. In addition to that is regulation.

Where investments are federally regulated, all insurance products are regulated on the state level. A state needs to approve each individual and company doing insurance business in their state and holds the regulatory authority over their activities.

[Honeycombe8]

22. We have tort reform in TX. It did NOT lower ins. premiums.

As further proof, in our Dallas paper, there was a listing of all the wonderful things that have happened in TX since passing tort reform years ago. NOT in the list: lower ins. premiums. At the TOP of the list: Fewer insurance claims.

What tort reform did: Put more money in the pockets of ins. cos., who did NOT pass on the $ to policy holders.

[Skittles]

23. CORRECT