<p>Another domino falls: Indiana is going for Medicaid expansion.
<a href=“http://www.chicagotribune.com/news/sns-wp-washpost-bc-health-indiana15-20140515,0,1859161.story”>Chicago News - Chicago Tribune - Chicago Tribune;
<p>The issue is more properly selling insurance across state lines. Buying a policy across state lines is fine. It’s legal now for a California family to buy an Illinois policy for their kid at the University of Chicago.</p>
<p>But each state has its own insurance regulations. Insurers selling in California have to follow the California rules, for example. If selling across state lines were permitted, then a company could use the North Dakota rules for California policies. It’s reasonable to expect that if selling across state lines were permitted, states would have a rush to the bottom, and all insurers would follow rules of the state with the least restrictive rules.</p>
<p>Class action filed in San Francisco accusing Blue Shield of misrepresentation of its provider network.</p>
<p><a href=“California consumers say duped by Blue Shield's limited Obamacare plans”>California consumers say duped by Blue Shield's limited Obamacare plans;
<p>That should make insurers sit up and take notice.</p>
<p>“If selling across state lines were permitted, then a company could use the North Dakota rules for California policies.”</p>
<p>So what. Maybe North Dakota rules make more sense than Ca rules. It is almost irrelevant these days since federal rules supersede state rules for the most part. For instance, almost all the important stuff like essential benefits, deductibles, out-of-pocket maximums and actuarial value are determined by the federal govt. I am suggesting these rules don’t make much sense and should be relaxed so people can choose from a menu of plans with varying benefits. If someone wants a very high deductible and no mental health benfits, let them have it. Some regulations like prohibiting annual and lifetime benefit caps should probably be retained.</p>
<p>Covered California should also be sued. They published those provider network lists, too.</p>
<p>
</p>
<p>What about people who lacked insurance because they simply couldn’t afford it? You were in the fortunate position of being able to pay $1000 a month. But believe it or not, lots of people couldn’t. </p>
<p>
I’ve always had insurance. I don’t have any pre-existing conditions. It isn’t about ME. It’s about the fact that having no insurance at all is a lot bigger problem than having insurance with a smaller network than you would like. </p>
<p>Instead of having these burdensome rules governing subsidies with extremely complicated back end systems and the IRS attempting to police the entire enterprise, I would prefer to see Medicaid expanded for the poor - although those above the poverty thresholds should have to make some type of payment for it. </p>
<p>Btw, I worked in a bakery, too, back then. The number of sugary items sold was huge- and this was in a high SES area, to people using their own money. So, what conclusions? </p>
<p>But just saying: people’s personal complaints about food stamps and their users don’t really belong on this thread. Diabetes, as part of health coverage and costs is one thing, venting is another. </p>
<p>And on venting, we don’t need the continued flames either, as in “anathema to the progressives out there who think all us need the nanny state to hold our hands and make all the decisions for us.” We’re supposed to avoid this sort of cracks, stay off political and inflammatory. </p>
<p>Going back a step- the continuous coverage issue allowed for up to a 63 day (or so) break. Someone should look at how that holds today. (Was quoted to me last summer.) </p>
<p>I don’t see how feasible it becomes for folks to pick and choose their specific benefits, unless they are considerably knowledgeable about their health today and potential issues going forward. That requires, uh, medical attention. And a crystal ball. A male or older female isn’t expected to get pregnant. What else can you reasonably predict? Based on what knowledge of medicine and medical research and stats. (If anything, this thread shows me how little people know, other than their own to-date experiences.)</p>
<p>I also think folks should think a bit deeper about high risk pools- what someone is currently experiencing versus what could pose a future issue- or not. You want to move everyone over, who has, say elevated BP? Or you want special pools for those who had heart attacks- or only those who, say, had cancer diagnosed? And what level of cancer would that be- a bad mole or something more critical? Family history or your own actual health status and patterns? Sounds like a lot of oversight and admin complexity, to me. The same big govt intrusion some decry. Seems people accept this intrusion when they assume it would mean it’s for 'the other guy, not me." Odd.</p>
<p>"WalMart every other Friday is the best place to gather this data. But, it’s going to be crowded. "</p>
<p>I grocery shop at Walmart every other Friday. </p>
<p>“If selling across state lines were permitted, then a company could use the North Dakota rules for California policies.”</p>
<p>GP responded “So what. Maybe North Dakota rules make more sense than Ca rules.”</p>
<p>States regulate insurance companies in order to protect their own citizens from buying from companies that go under or otherwise take money and end up not providing the product. </p>
<p>It’s not about ND vs CA rules NOW. It’s about what they would become. If companies can sell across state borders, then the states lose interest in the consumers and focus instead on the insurers as revenue sources. Follow the money: ND would want to receive state taxes, and also attract business for hotels, lawyers, accountants, etc. The result would be a few states would reduce their oversight to nonexistent to lure the insurance companies to relocate there, knowing they’re not really selling to ND citizens. The consequence would be shaky, quick-hit insurers domiciled in those states and selling to unsuspecting consumers elsewhere. </p>
<p>Older but interesting. I mentioned we had, at some point, a 7-state compact in New England- and one of the proponents of this current cross-border talk said it didn’t make sense. Maybe someone besides me is getting annoyed some posters forget what they wrote (or forget what stands they took, ha.)
<a href=“http://www.phillyburbs.com/lifestyle/your_health/want-to-buy-insurance-across-state-lines-we-got-a/article_50549a5c-4060-11e0-968d-00127992bc8b.html?mode=jqm”>http://www.phillyburbs.com/lifestyle/your_health/want-to-buy-insurance-across-state-lines-we-got-a/article_50549a5c-4060-11e0-968d-00127992bc8b.html?mode=jqm</a></p>
<p>More background. <a href=“FAQ: Selling Health Insurance Across State Lines | KFF Health News”>http://www.kaiserhealthnews.org/stories/2010/september/30/selling-insurance-across-state-lines.aspx</a></p>
<p>Wouldn’t it be fun, all these companies negotiating with docs, all those admins needing to understand and deal with a wide variety of policies, call all over for clarification. Streamline? Only in the best of cases, a tidy area like New England, where so much is already cross-border. Some of you folks are suggesting massive overhead, you don’t seem to realize. And someone can check for whether any of this idea is still “live.” KFF said that it hadn’t yet gotten far, but that’s an old report.</p>
<p>As Hayden says, local insurers wouldn’t have the same natural interest in consumer issues in a distant area. </p>
<p>
The group insurance quotes I have received include an option for infertility coverage. A company will offer plan A - with say $4500/deductible PPO network etc - and then offer the exact same plan with the addition of infertility coverage. The additional premium is the only difference.</p>
<p>
I would conclude that those customers were spending their discretionary food budget. They could buy the pastry and then still eat at the high priced salad bar for lunch. Those on a limited food budget (food stamps) however, were choosing the pastry instead of the salad. </p>
<p>
</p>
<p>Right, but it is ILLEGAL for a Santa Cruz EPO family to insure their California kid, who is a teenager, who attends the University of Chicago. Your position seems inconsistent, CF. In one case, you support diet’s pov that EPO should have larger networks, at least grouped counties. Yet, you draw the line at grouped states? Why? (It’s the exact same issue: <26 year old kid covered under family policy attending college out of the service area.)</p>
<p>
</p>
<p>As Hillary might say, "what difference does it make?’ In other words, if all plans are ACA compliant, ND plans are federally-approved, as are California plans.</p>
<p>BB, the links- and more like them- mention different regulatory interests in different states, sometmes based on their health related issues, sometimes their general stance. Eg: “Insurance is currently regulated by states. California, for instance, says all insurers have to cover treatments for lead poisoning, while other states let insurers decide whether to cover lead poisoning, and leaves lead poisoning coverage – or its absence – as a surprise for customers who find that they have lead poisoning. … The result of this is that an Alabama plan can’t be sold in, say, Oregon, because the Alabama plan doesn’t conform to Oregon’s regulations.” [Washington Post, 2/17/10].</p>
<p>When these ideas have interest, you can see what the ongoing discussion and context are. </p>
<p>
I don’t understand why one would support the arbitrary lines of state borders when it comes to selling insurance but on the other hand support a centralized federal system which was put into place to implement and manage a system which applies to all states. Either it is better to have the individual states manage and oversee the health insurance industry, or it is better to have the federal government do so. The ACA promised to add a layer of uniformity, transparency and consumer protection to what was deemed a broken private system. However, now when problems are bubbling to the surface - the limited networks in CA - a consumer can sue the insurance company but NOT the feds or CA. </p>
<p>
Again, either it is a good idea to run this behemoth from DC or it is not. There are those that hold up Romney care as an example of the supposed successful trial of the ACA. It was STATE run!</p>
<p>So it’s okay for the central agency to state what must be covered - even is a good portion of folks don’t want or need that particular coverage - but it’s not okay for someone in Alabama to decide they don’t want lead coverage, but maybe they would like lyme disease coverage (assuming OR offered that but not AL.)</p>
<p>Again addressing the support for banning the sale of health insurance policies across State lines…</p>
<p><a href=“http://www.census.gov/compendia/statab/2012/tables/12s0016.pdf”>http://www.census.gov/compendia/statab/2012/tables/12s0016.pdf</a></p>
<p>Florida has 17.% of it’s population over the age of 65. Florida should be able to make birth control and pre/post natal care optional. On the other hand…certain name brand pharmaceutical should be covered at 100% :).</p>
<p>Either one supports the ability of states to run their own system or they don’t.</p>
<p>More jobs for bureaucrats and less of a chance that any one agency or person is responsible when things go wrong.</p>