<p>That’s not illegal. The Santa Cruz family can buy an Illinois insurance policy for the California kid who lives in Chicago. Some posters in this thread have either bought, or at least talked about buying, policies in the state where their kid goes to school.</p>
<p>
</p>
<p>You got my position wrong on both issues. I DON’T support dietz’s proposal about grouped counties. And I didn’t take a position on GP’s idea about cross-state sales; I was merely explaining how it would work: If selling across state lines were permitted, then a company could use the North Dakota rules for California policies is an explanation about how GP’s proposal would work.</p>
<p>I haven’t decided whether I think the federal regulations for adequacy of coverage are good enough. California requires that insurers cover more than what the feds require. So, should someone who lives in a state that requires coverage of woo-woo “medicine” like crystal aura healers be able to buy from an insurer based in a sensible state? I’m not sure. If the regulations in most states are pretty similar, then a California insurer buying a North Dakota policy won’t save much money: North Dakota insurers and California insurers would both have to pay those expensive Los Angeles doctors that their Los Angeles customers go to.</p>
<p>The California people suing Blue Shield are suing in California state court. What would they do if they bought their policy from a North Dakota insurer-- sue in North Dakota court? I suspect North Dakota courts would be more sympathetic to North Dakota companies than to California consumers. There’s the argument for keeping it in-state, right there: California regulators might not be doing a great job looking out for California consumers, but North Dakota regulators would be worse, much worse.</p>
<p>Pretty hypocritical of seniors not wanting to pay for premature babies, when all of us are paying for their health care. They should come back to us when they start paying for their own joint replacements and heart attacks.</p>
<p>“A federal state [the US] is a political entity characterized by a union of partially self-governing states or regions under a central (federal) government. In a federation, the self-governing status of the component states, as well as the division of power between them and the central government, are typically constitutionally entrenched and may not be altered by a unilateral decision of either party, the states or the federal political body.” </p>
<p>Not so much the seeming arbitrariness of borders, but that each state is an entity within the whole. In some cases, each can supplement or augment a fed law, as long as it doesn’t change the intention. I think it is a good idea to have the Feds decide what’s good for the whole. But, leaving some issues to the specific states’ needs. You have drought, we don’t. You have a far more massive set of immigrant health and education issues than we do. The problem comes when individual states (or pieces of them) go screw things up. </p>
<p>Instead of ND, you could have used AZ as an example- it’s contiguous. Aspects of the population are similar. Maybe S Californians should be able to buy from an AZ company. But it’s not a panacea. As KFF notes, “There are also fears that consumers dealing with out-of-state companies would have difficulties resolving disputes. And, since health costs vary geographically, insurance purchased in one state might not cover as much of the cost of care in a more expensive state.” This needs project mgt style thinking.</p>
<p>CA is complicated by the extraordinary diversity on all counts. </p>
<p>The idea is the insurer sets a certain reference price for a common procedure like cataract surgery or joint replacement. If the provider, even the in-network provider, charges more than the reference price, then the consumer pays the difference.</p>
<p>I hope the regulators took care to make sure that the reference price had to actually be available to the consumer. </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.”</p>
<p>Dietz, there’s a disconnect here - we’re talking about two completely different types of oversight. The ACA defines the benefits that an insurance company must offer, etc. The states do this occasionally. But the real work the states do is monitor how the specific insurance companies are run. The states review each company domiciled in its borders to see, for example, if it has sufficient capital to run operations and pay it bills, if it has enough funds to pay its claims, they review each company’s actuarial assumptions, etc. </p>
<p>That’s what I meant when I said the states care about the consumers, and they monitor all insurance companies for the consumers so that if you pay money for car insurance, the insurance company has enough money to pay a claim you present to them. </p>
<p>If North Dakota had companies which wrote in the other 49 states, they would not care much if the company went bankrupt because most of the people who would suffer wouldn’t be from ND. </p>
<p>CF, the Sac Bee article says, “Most insurance now pays a percentage of costs, and those costs themselves can vary from hospital to hospital. Now if you pick a more expensive hospital, the insurance still pays the same percentage.” [But wait, I thought we had negotiated rates. And your plan pays a specified % of those.] </p>
<p>“The new strategy works like this:
Your health insurance plan slaps a hard limit on what it will pay for certain procedures, for example, hospital charges associated with knee and hip replacement operations. That’s called the reference price.
Say the limit is $30,000. The plan offers you a choice of hospitals within its provider network. If you pick one that charges $40,000, you would owe $10,000 to the hospital plus your regular cost-sharing for the $30,000 that your plan covers.”</p>
<p>CalPers has been using some ref pricing since 2011.
“Previous research indicates the CalPERS reference pricing initiative saved money without shifting significant costs to enrollees or sacrificing quality.”</p>
<p>I read the article, but it wasn’t clear on what protections are offered for the consumer. I’m in favor of reference pricing, but I’d want to make sure that if the insurer set a reference price of $30K for a joint replacement, I could actually go to a hospital that charged $30K. Otherwise, what’s to prevent the insurer from setting a reference price of 29 cents?</p>
<p>GP, you got your wish. A large Medicaid expansion is in fact an important piece of ACA. Of course, some states rejected it, for no good reason and to their detriment. Many millions of people remain uninsured in those states who would have been covered under the expansion. Hospitals in those states continue to be burdened with providing care to uninsured people who would have been covered under the expansion. </p>
<p>But better late than never. Some states are re-thinking their mindless opposition; see, for example, Indiana. </p>
<p>Of the five reference pricing procedures: four are procedures primarily affecting seniors. Cataract surgery, knee and hip replacement and colonoscopies (advised for those over 50). Is this a back door way to get older people to pay more as a sort of offset to the lower relative premiums. (since they get a break on insurance premiums under the new law)?</p>
<p>There isn’t even enough written about this yet to know answers. One article says we’re two years off. The HChange article sure seems to say CalPers patients are informed of their choices. </p>
<p>It’s only a shift to get older people to pay more IF they choose a more expensive facility. No one says here are your options, go to the most expensive. </p>
<p>Tpg, nice link- I find that level of medical research fascinating. </p>
<p>“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>One need only look at the credit card industry when they all rushed to incorporate in South Dakota due to that state’s lax regulation and it’s effect on the consumer to know that it’s a bad idea for the consumer if insurance companies are allowed to sell across state lines. </p>
<p>I am changing my position. After listening to all the horrible reports on the VA system, we should not go anywhere near a 50 state wide health insurance system. And certainly not run by one central entity.</p>
<p>I don’t see how it would be, because it applies to insurance companies, not Medicare. I guess Medicare Advantage insurance companies would be allowed to use reference pricing, but most seniors are still in regular old Medicare.</p>
<p>I dunno, lots of things are centrally run. Biggest being IRS. There’s FAFSA. Direct loans decentralized some of the responsibility- sometime in the last two years- there’s a funky improvement. Ie, not. </p>
<p>Another data point on electronic medical records: The office I go to, a big medical clinic, has been using electronic medical records (EMR) for years. At a visit today, I asked the doctor I saw, a woman who is maybe 40, whether she liked EMR. She said that it had taken her awhile to get used to them, but she is now enthusiastic. She liked that whereas in the old paper chart days, maybe twice a day she’d see a patient with no chart because the chart was somewhere else in the building, but now she has everyones’ records. She also liked how when she prescribes a drug, it’s automatically cross-checked against a patient’s allergies and other medications.</p>