And It Gets Worse: They Are Called “Nationwide Plans,” And They Do Gut State Regulations - FDL

[WillyT]

They Are Called “Nationwide Plans,” And They Do Gut State Regulations
By: Jon Walker Friday December 18, 2009 11:51 am

<snip>

Ezra Klein has done the discussion on health reform a big disservice by making false claims about what could, in fact, start a race to the bottom in the insurance market. He writes:

What it doesn’t allow is for insurers to simply sell their wares in any state. Aetna could not, for instance, decide that Indiana’s lax insurance regulation made it an appealing state to headquarter in, and then sell insurance that conformed to Indiana’s standards in New York. Thus, there’s no race to the bottom unless states want to have a race to the bottom. But it’s not clear why they’d want that.

That is completely wrong. The Senate bill would allow for things called “nationwide plans.” These plans would be based in one state, and could sell in any other state (unless the states pass a law opting-out of the program, but Snowe is working to get rid of the opt-out), while ignoring those other state’s regulations. To quote the bill section 1333:

(b) Authority for Nationwide Plans-
(1) IN GENERAL- Except as provided in paragraph (2), if an issuer (including a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark) of a qualified health plan in the individual or small group market meets the requirements of this subsection (in this subsection a `nationwide qualified health plan’)–
(A) the issuer of the plan may offer the nationwide qualified health plan in the individual or small group market in more than 1 State; and
(B) with respect to State laws mandating benefit coverage by a health plan, only the State laws of the State in which such plan is written or issued shall apply to the nationwide qualified health plan.

It clearly says right there in the bill that Aetna could set up shop in Indiana and sell insurance in New York that only meets Indiana’s lower standards. This could produce a race to the bottom. The worst part is that it is an “opt-out” and not an “opt-in” program (unless Snowe succesfully removes the opt-out). States would not be able to act in time to prevent their regulations from effectively being gutted by “nationwide plans.” Nationwide plans nullify state laws regulating what kinds of health insurance must be sold in their state.

<snip>

Link: http://fdlaction.firedoglake.com/2009/12/18/they-are-called-%E2%80%9Cnationwide-plans%E2%80%9D-and-they-do-gut-state-regulations/

:banghead:

[msongs]

1. once again dems disrespect the citizens of the USA in the name of corporate whoring nt

[sandnsea]

2. The House bill has a nationwide exchange too

And it allows for states to create compacts so they can have more buying power. And it is written so that the state regulations cannot be over-written.

I cannot believe how irresponsible these people they are. So little of what they have said is true.

[WillyT]

4. This Has To Do With The Senate Bill, You Know...

The Baucus/Finance Committee Bill... the one the President wants.

:shrug:

[depakid]

7. The US Senate has become nothing less than the province of robber barons

[sandnsea]

8. And 90% of it is identical

And the Baucus Bill has been changed and these people don't even know what the changes are. But man I'd be tempted to say any damn thing if I were getting a million dollars in donations every couple of days too.

[WillyT]

12. A Couple Of Things Here:

1) They've been saying 80, 85, and now 90 percent of the bill is wonderful for some time now. Sounds great until you find out the part they are willing to leave behind is the Public Option, the Medicare Buy-In, etc... I guess that's the NEW donut-hole in Health Care, and they were the ONLY things that make ANY mandate palatable.

2) We can only go by what they've given us in writing to look at. I know things are fluid, since they are still negotiating, and therefore hammering out new language as deals get made and votes secured. But since we are not in on the negotiations, we have to go by what we do have in front of us, otherwise...

3) We have to just shut up and TRUST THEM??? Is that your position? Because that ship sailed last Sunday and Monday mornings as Joementum secured the blessings of the White House to just cut a deal.

At that moment, my willingness to "just trust them, the know what they're doing" totally, and utterly evaporated.

:shrug:

[truedelphi]

20. I think this is the only option left for many of us, right here:

We the undersigned and uninsured American citizens do hereby
renounce our American citizenship, and henceforth declare ourselves to be citizens of:
__________________________________

Signed and dated

__________________________________


(To fill in the first blank - any industrialized nation will do. Some may choose Canada, but I think France has good wine and cheese!)

[pnwmom]

16. The President doesn't "want" that bill over the House one. n/t

[WillyT]

18. That's Not The Reporting That I've Been Reading

:shrug:

[juno jones]

3. K&R! n/t

[lib2DaBone]

5. 2094 pages and still growning... only 1 Senator has read this bill

"The big print giveth... the fine print taketh away"

[Canuckistanian]

6. Where are those Dean-bashers now?

"A race to the bottom" - where have we heard that phrase before? Oh, yeah. Free Trade, outsourcing, pollution control, labor protection, minimum wages, consumer rights, etc, etc....

Kill. The. Bill.

[walldude]

9. Yeah DeMint was all over the radio today trying to convince people

that completely deregulating the Insurance industry is a better way to foster competition than a public option. Because you know, those corporate execs are such nice people that they won't do anything to screw over the public. They can police themselves just like the FUCKING BANKS DID.

[dgibby]

11. And he is rapidly becoming the poster boy for the tea baggers

and radical right. Watch for a WH run in 2012. If he ever gets in, we are even more screwn than we were with Bush.

[Zodiak]

10. I've been screaming about this lately!

It's a GIGANTIC HOLE in cost control, and any claimed cost control measures will have to be weighed against the effect of this.

Ezra, like so many who have come out in defense of this bill, is not being intellectually honest when he says "it is not clear why states would want to do this".

He is a big-time columnist, and so I am giving him credit for his intelligence here because he cannot have that job and be that stupid. He is simply not being honest.

There are multiple examples of states having races to the bottom for competition and jobs. The credit card race to the bottom was won by Deleware, the most usurious state laws in the nation.

Most states seem to have competitions to see who can have the least stringent worker laws like minimum wage and benefits requirements (and cities for that matter) so they can attract big business to their towns to give people jobs.

And Ezra doesn't see how states would want to compete with each other for Aetna's jobs?


This is what burns me up the most....they are not being intellectually honest at all. They are lying through their teeth at every step of the way, acting like "they are the adults". Yeah, adults in the way every kid is told there is a Santa Claus.

[upi402]

17. I hold smart folks like Obama to the same honesty test

They don't need us to tell them what's right. They're smart and they're feeding us BS and calling it beef substitute. It's propaganda and there's payday for all those going with the tide of cash flow.

[Zodiak]

19. In the eyes of the Beltway, it is an unfortunate side effect

An energized base that became that way because they learned to sift through BS is not going to suddenly turn stupid just because the parties changed. We STILL know how to sift through bullcrap.

The fact that I have been told that Obama is a genuis perhaps fuels a bit of my anger...I give him credit for every ounce of intelligence he has, and he just cannot be this unbelievably stupid.

I have even entertained the idea that he is "crazy like a fox" and is pissing off his base to pull the bill out of the hands of the conservadems and back to the table, but the attacks against the left are so virulent and so logically fallacious that it stuns me with the hubris of it all....no one with political savvy would be that vicious to the very people who had the most hope in him.

[upi402]

23. Yep, it's cemented for me. He's not on the side of the people

He's a corporatist to the marrow. Some here are much kinder, or something, than me. They say we need to educate him, or show Obama the way.
No, he's showing us the finger and we need to open our damn eyes to it.

Third party time for me. There is no opposition party now, so may as well.

[pinto]

13. One key here may be the "Paragraph 2" mentioned in the article, but not quoted in the article -

SEC. 1333. PROVISIONS RELATING TO OFFERING OF PLANS IN MORE THAN ONE STATE.

(a.)(2) STATE AUTHORITY.—

A State may not enter
into an agreement under this subsection unless the
State enacts a law after the date of the enactment
of this title that specifically authorizes the State to
enter into such agreements.

(Pages 219 - 220)

http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf (big pdf file)

Seems to say that unless a State Legislature legalizes the agreements for interstate offerings they are illegal. Some well may approve, which would support Klein's assessment, but it also seems to imply that States with strict insurance regulations could opt to *not legalize* interstate offerings by simply *doing nothing*. Unless I'm misreading the meaning of "except as provided in paragraph (2)". ~ pinto

:shrug:

[quaker bill]

14. What is a "qualified" health plan?

If there is a uniform standard of coverage and medical loss ratio for a "qualified" health plan, I don't get the problem. Nationwide plans only nullify state laws to the extent they meet standards to be "qualified". There can be no "race to the bottom" because plans below the threshold for "qualified" are not protected from state regulation and cannot be sold across state lines.

To my mind, it all depends on the threshold for "qualified". If the standard is too low, now that could be a problem. Any idea on what the standard is, or is this thread simply more hand wringing histrionics?

[Laelth]

15. k&r for the truth, however depressing. n/t

:dem:

-Laelth

[laughingliberal]

21. Yep. The #1 worst part of the McCain plan. As bad as his plan was, this was the part that would do

the most damage, long run. And we adopted it. How special!

[DeltaLitProf]

22. Very misleading piece here by the FDL blogger

The firedoglake blogger does not define at all what a "nationwide qualified insurance plan" is and assumes it's going to be a lowest common denominator plan. I took a look at the latest bill. As you can see, not just any old fly-by-night insurance company with a PO box in Mississippi is going to be qualified:

http://thomas.loc.gov/cgi-bin/query/F?c111:4:./temp/~c1119GyLGj:e140844:

SEC. 1301. QUALIFIED HEALTH PLAN DEFINED.

(a) Qualified Health Plan- In this title:

(1) IN GENERAL- The term `qualified health plan' means a health plan that--

(A) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in section 1311(c) issued or recognized by each Exchange through which such plan is offered;

(B) provides the essential health benefits package described in section 1302(a); and

(C) is offered by a health insurance issuer that--

(i) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title;

(ii) agrees to offer at least one qualified health plan in the silver level and at least one plan in the gold level in each such Exchange;

(iii) agrees to charge the same premium rate for each qualified health plan of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and

(iv) complies with the regulations developed by the Secretary under section 1311(d) and such other requirements as an applicable Exchange may establish.

(2) INCLUSION OF CO-OP PLANS AND COMMUNITY HEALTH INSURANCE OPTION- Any reference in this title to a qualified health plan shall be deemed to include a qualified health plan offered through the CO-OP program under section 1322 or a community health insurance option under section 1323, unless specifically provided for otherwise.

(b) Terms Relating to Health Plans- In this title:

(1) HEALTH PLAN-

(A) IN GENERAL- The term `health plan' means health insurance coverage and a group health plan.

(B) EXCEPTION FOR SELF-INSURED PLANS AND MEWAS- Except to the extent specifically provided by this title, the term `health plan' shall not include a group health plan or multiple employer welfare arrangement to the extent the plan or arrangement is not subject to State insurance regulation under section 514 of the Employee Retirement Income Security Act of 1974.

(2) HEALTH INSURANCE COVERAGE AND ISSUER- The terms `health insurance coverage' and `health insurance issuer' have the meanings given such terms by section 2791(b) of the Public Health Service Act.

(3) GROUP HEALTH PLAN- The term `group health plan' has the meaning given such term by section 2791(a) of the Public Health Service Act.