Trump's Full Court Press on healthcare

[stessier]

As long as the company has to follow the rules of the state it is selling into, I don't see what the problem is either.

[LordMortis]

As long as the company has to follow the rules of the state it is selling into, I don't see what the problem is either.

This. I'm missing something, apparently.

[stessier]

Ahhh - if this article is to be believed, that is not the case.

The idea seems simple enough. Right now, if you are buying your own health insurance, that coverage must be sold by an insurer regulated in your state. Instead of a national market, health insurance is sold in 51 state markets (including D.C.) with differing regulations.

According to proponents, insurers should be allowed to sell health insurance according to the rules of a single state of their choosing, regardless of where their customers live. That would promote “regulatory competition” among the states, who would have an incentive to attract insurers by reducing unnecessary regulation. Insurance costs would decline as plans become tailored to the demands of consumers, rather than continuing to provide a list of benefits that increase costs but do not provide value for major segments of the market.

Yes - this would be a bad thing.

[RunningMn9]

Ever had to deal with an out-of-state health insurer?

I have no particular ideological aversion to allowing insurers to sell across state lines. But if any insurer that wants to sell health insurance in NJ has to conform to NJ regulations, nothing will change. There won't be a rush of cheap out-of-state policies suddenly available to me.

If the insurer doesn't have to conform to NJ regulations, well, I'm sure you can see the problem with that.

[RunningMn9]

And the most important question - in what jurisdiction do I sue them?

[LordMortis]

And the most important question - in what jurisdiction do I sue them?

Mine... Or yours for you...

[LawBeefaroni]

Also don't forget the providers. You think it's a be mess now, where the majority of patients are insured under one set of rules, imagine providers having to deal with 50 sets on a regular basis.

As RM9 notes, even the occasional out-of-state patient is a problm. Imagine the majority of patients being out of state via insurance. Total disaster.

[Exodor]

And the most important question - in what jurisdiction do I sue them?

None because I suspect these across state line policies will require arbitration to settle any disputes.

[RunningMn9]

And the most important question - in what jurisdiction do I sue them?

Mine... Or yours for you...

The correct answer is: Theirs.

Having been through this, my option was to sue the insurer in Alabama. Which I couldn't physically do.

[El Guapo]

Also don't forget the providers. You think it's a be mess now, where the majority of patients are insured under one set of rules, imagine providers having to deal with 50 sets on a regular basis.

As RM9 notes, even the occasional out-of-state patient is a problm. Imagine the majority of patients being out of state via insurance. Total disaster.

Well, I think the problem would be more that every insurance company would use the rules of the state with the laxest regulations, as you see with corporations and credit card issuers. So I think it's less having to deal with 50 sets - 99% of the time you'd be dealing with one or two state regulations. It's just that interstate insurance sales would effectively eliminate state regulation of health insurers.

[Isgrimnur]

There are reasons all the credit card companies operate out of Delaware, and it certainly isn't consumer protection. Besides, it's not across state lines that's the worry, it's in- vs. out-of-network. A Hawaii-based health plan might seem attractive, but given that I'm half a world away from every in-network doctor, something I may not be able to determine until it's too late, would kinda suck.

[Max Peck]

From last year: Selling health insurance across state lines is a favorite GOP 'reform.' Here's why it makes no sense

Of all the healthcare reform nostrums in all the world, the most popular among Republicans in the U.S. is allowing the sale of insurance policies across state lines.

The idea has been part of every GOP proposal to “repeal and replace” Obamacare. It was written into GOP presidential candidate John McCain’s platform in 2008 and Mitt Romney’s in 2012, and shows up right there in paragraph two of President-elect Trump’s healthcare policy statement.

To healthcare economists and other experts in the field, however, the idea is nonsense. Here’s Austin Frakt of Boston University and the Department of Veterans Affairs: “I never understood the appeal of this idea. It only makes sense if you don’t know what you’re talking about.”

In fact, not even insurance companies like it.

Selling insurance across state lines is a vacuous idea, encrusted with myths. The most important myths are that it’s illegal today, and that it’s an alternative to the Affordable Care Act. The truth is that it actually is legal today and specifically enabled by the Affordable Care Act. The fact that Republicans don’t seem to know this should tell you something about their understanding of healthcare policy. The fact that it hasn’t happened despite its enablement under the ACA should tell you more about about why it’s no solution to anything.

...the ACA already allows states to reach compacts with other states to allow cross-border insurance sales (compacts are essentially interstate treaties). Georgia, Maine and Wyoming have passed laws enabling such compacts. No other states have joined them, and not a single insurer has expressed any interest in taking advantage of them. According to the Urban Institute, Georgia’s law permits insurers to sell policies that have been approved in other states, and Maine’s law allows the sale of policies approved in Connecticut, Massachusetts, New Hampshire, or Rhode Island.

As the Georgetown University study team observed, laws allowing cross-state health insurance sales have no organized champions. Consumers aren’t clamoring for them; insurers aren’t interested in them; doctors and hospitals don’t care; and state regulators aren’t inclined to cede their oversight to interlopers from somewhere else. Their only backers are preening political candidates who don’t understand health insurance and hope you don’t, either.

“Selling insurance across state lines” is a slogan, not a policy, and it deserves to be consigned to the dustbin of empty promises.

[LawBeefaroni]

Also don't forget the providers. You think it's a be mess now, where the majority of patients are insured under one set of rules, imagine providers having to deal with 50 sets on a regular basis.

As RM9 notes, even the occasional out-of-state patient is a problm. Imagine the majority of patients being out of state via insurance. Total disaster.

Well, I think the problem would be more that every insurance company would use the rules of the state with the laxest regulations, as you see with corporations and credit card issuers. So I think it's less having to deal with 50 sets - 99% of the time you'd be dealing with one or two state regulations. It's just that interstate insurance sales would effectively eliminate state regulation of health insurers.

Eventually. But you'd have several years of state lawmakers pissing about.

There are reasons all the credit card companies operate out of Delaware, and it certainly isn't consumer protection. Besides, it's not across state lines that's the worry, it's in- vs. out-of-network. A Hawaii-based health plan might seem attractive, but given that I'm half a world away from every in-network doctor, something I may not be able to determine until it's too late, would kinda suck.

I thought credit cards were Nebraska and South Dakota (usury laws) and incorporation was Delaware.

[pr0ner]

I heard a Trump speech on the local news just now saying they have the votes for Graham-Cassidy but they can't get it done in time for reconciliation. Where are the votes coming from?

[Zaxxon]

Believe me, he has all the best votes.

[Combustible Lemur]

I heard a Trump speech on the local news just now saying they have the votes for Graham-Cassidy but they can't get it done in time for reconciliation. Where are the votes coming from?

He got confused, a senator who was sick had a doctor's appointment and wwas getting better at home. Trump thought he was incapacitated at a hospital.

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[Kraken]

I heard a Trump speech on the local news just now saying they have the votes for Graham-Cassidy but they can't get it done in time for reconciliation. Where are the votes coming from?

I just don't believe anything Trump says unless other sources confirm it.

[malchior]

I heard a Trump speech on the local news just now saying they have the votes for Graham-Cassidy but they can't get it done in time for reconciliation. Where are the votes coming from?

He got confused, a senator who was sick had a doctor's appointment and wwas getting better at home. Trump thought he was incapacitated at a hospital.

It is sad that I can't tell if this is a joke or an actual observation.

[Grifman]

The other thing that makes no sense about selling across state lines - most insurance plans that I have had have networks of preferred doctors/medical facilities. You pay less in network and more out of network. An out of state insurance plan isn't going to have a network in your state! So is anyone going to choose a plan that doesn't have any doctors/medical facilities in your state in their network? is anyone going to want to pay more because every bill they get will be out network? It doesn't make any sense for this reason also.

[Combustible Lemur]

I heard a Trump speech on the local news just now saying they have the votes for Graham-Cassidy but they can't get it done in time for reconciliation. Where are the votes coming from?

He got confused, a senator who was sick had a doctor's appointment and wwas getting better at home. Trump thought he was incapacitated at a hospital.

It is sad that I can't tell if this is a joke or an actual observation.

According to Rachel Maddow, it's the only reference she could find to a senator actually being sick this week. Seeing as Mcain is in dc and a definite no. It was a tweet saying I was sick but just stayed home, not hospitalized! Shortly after trump's comment.

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[RunningMn9]

The other thing that makes no sense about selling across state lines - most insurance plans that I have had have networks of preferred doctors/medical facilities. You pay less in network and more out of network. An out of state insurance plan isn't going to have a network in your state! So is anyone going to choose a plan that doesn't have any doctors/medical facilities in your state in their network? is anyone going to want to pay more because every bill they get will be out network? It doesn't make any sense for this reason also.

That's based on how things work now. If policies can be sold across state lines without having to adhere to the rules of each individual state, what would prevent insurers from creating national plans focused on a national network of providers?

[Max Peck]

The other thing that makes no sense about selling across state lines - most insurance plans that I have had have networks of preferred doctors/medical facilities. You pay less in network and more out of network. An out of state insurance plan isn't going to have a network in your state! So is anyone going to choose a plan that doesn't have any doctors/medical facilities in your state in their network? is anyone going to want to pay more because every bill they get will be out network? It doesn't make any sense for this reason also.

That's based on how things work now. If policies can be sold across state lines without having to adhere to the rules of each individual state, what would prevent insurers from creating national plans focused on a national network of providers?

According to the LA Times story I linked above, the insurers themselves are preventing it due to their desire to make profits instead of losses.

The key is that healthcare is almost always delivered locally. Even if a Southern Californian’s insurer is located in, say, Idaho, his or doctors and hospitals are almost certain to be nearby. To provide coverage, Joe’s Insurance would have to make network deals with local providers in its new markets, creating its own local networks and agreeing on fees.

The typical tradeoff in such deals is that Big Insurer A promises Hospital B access to its thousands of local enrollees, if Hospital B agrees to treat them at a preferential rate. Mayhew, who does this stuff for a living, tells us: “Insurers have leverage against providers when the insurer can credibly promise to direct a large number of covered lives to or from a particular provider. Providers have leverage when they don’t think that the insurer is bringing a lot of members.”

Insurers entering a new state from far away will have no leverage because they’ll be building their customer base from scratch. They'll be able to offer only minimal business to hospitals or doctors in their new state. They’ll have to pay premium rates to attract these providers, at least at first; yet to attract customers they’ll have to offer competitive premiums.

Multi-state networks do exist in some places, chiefly metropolitan areas that span several states; an insurer in the Washington, D.C., market needs to offer a network of doctors and hospitals in the District, Maryland and northern Virginia, for example.

Everywhere else, offering high reimbursements to sign up doctors and hospitals and low premiums to sign up customers is a formula for big losses. One could argue that such a loss-leader strategy might work in the long run, but big U.S. insurers such as Aetna and United Health have shunned the loss-leader game under Obamacare — they’ve pulled out of the market because they’re unwilling to sustain losses until it stabilizes. What makes anyone think they’d jump back in?

[LawBeefaroni]

It's not like there are no national networks now. All the large insurers have national PPO networks. They even have regional physician pricing. The problem will be negotiating lower rates locally, particularly for HMO networks.

No idea what risk sharing arrangements would look like. PHOs could become the de facto local networks. Hurts to think about.

[pr0ner]

I heard a Trump speech on the local news just now saying they have the votes for Graham-Cassidy but they can't get it done in time for reconciliation. Where are the votes coming from?

He got confused, a senator who was sick had a doctor's appointment and wwas getting better at home. Trump thought he was incapacitated at a hospital.

It is sad that I can't tell if this is a joke or an actual observation.

Actual observation, thinking Thad Cochran was in the hospital when he was recovering at home after an illness.

Still not sure how Trump thinks they'd have enough votes for Graham-Cassidy even if Cochran was in Washington.

[Max Peck]

Trump doesn't necessarily believe that he has enough votes. He just needs to make his base believe that he had the solution in hand, but the Democrats and McCain ran out the clock on him. And wouldn't it be wonderful if the Senate simply got rid of the filibuster so that he can make America great again.

[pr0ner]

So in other news, Trump lied?

[Remus West]

The man and his people are amazingly genius in their evil efforts to ruin the nation. Seriously, are they doing anything to attempt to help the middle class or is everything aimed at ruining Obama's work to strengthen us?

[Pyperkub]

Also don't forget the providers. You think it's a be mess now, where the majority of patients are insured under one set of rules, imagine providers having to deal with 50 sets on a regular basis.

As RM9 notes, even the occasional out-of-state patient is a problm. Imagine the majority of patients being out of state via insurance. Total disaster.

Well, I think the problem would be more that every insurance company would use the rules of the state with the laxest regulations, as you see with corporations and credit card issuers. So I think it's less having to deal with 50 sets - 99% of the time you'd be dealing with one or two state regulations. It's just that interstate insurance sales would effectively eliminate state regulation of health insurers.

Eventually. But you'd have several years of state lawmakers pissing about.

There are reasons all the credit card companies operate out of Delaware, and it certainly isn't consumer protection. Besides, it's not across state lines that's the worry, it's in- vs. out-of-network. A Hawaii-based health plan might seem attractive, but given that I'm half a world away from every in-network doctor, something I may not be able to determine until it's too late, would kinda suck.

I thought credit cards were Nebraska and South Dakota (usury laws) and incorporation was Delaware.

Yeah, South Dakota. Basically, those who refuse to learn from history are doomed to repeat it (to echo a few links above, here's another):

(Conservatives) want insurers to be able to cluster in one state, follow that state's regulations and sell the product to everyone in the country. In practice, that means we will have a single national insurance standard. But that standard will be decided by South Dakota. Or, if South Dakota doesn't give the insurers the freedom they want, it'll be decided by Wyoming. Or whoever.

This is exactly what happened in the credit card industry, which is regulated in accordance with conservative wishes. In 1980, Bill Janklow, the governor of South Dakota, made a deal with Citibank: If Citibank would move its credit card business to South Dakota, the governor would literally let Citibank write South Dakota's credit card regulations. You can read Janklow's recollections of the pact here.

[Smoove_B]

So today (10/2) President Trump declares as Child Health Day, which, on the whole, sounds like a respectable thing to do. However, the (R) controlled Congress just let CHIP expire...yesterday. I just can't...

Congress just allowed the Children’s Health Insurance Program, which provided low-cost health insurance to 9 million children, to expire.

If action is not taken soon to restore the funding, the effects will become obvious in schools across the country, with many of the children in the program unable to see a doctor for routine checkups, immunizations, visits when sick and other services.

The program, created under a 1997 law passed with bipartisan support during the administration of President Bill Clinton, provided coverage for children in families with low and moderate incomes as well as to pregnant women. It was instrumental in lowering the percentage of children who were uninsured from nearly 14 percent when it started to 4.5 percent in 2015. It was last reauthorized in 2015 and was due to be renewed by Sept. 30, 2017.

Here's the best part - Trump's second goddamn sentence in the proclamation:

How we treat our young people is a fundamental test of who we are as a society.

[El Guapo]

I assume the thinking is to get "Trump cares about child health" headlines mixed in with "CHIP expires" headlines. Or to get headlines like "Congress Lets CHIP Expire. Does Trump's 'Child Health Day' Suggest That He Supports CHIP?' headlines, so that the blame falls on Congress and not on him.

[Carpet_pissr]

In the wake of yet another mass shooting, you would think that some on the right would be pushing hard for increased healthcare, if only mental. Considering that the go-to, NRA-fed answer to all gun violence is "it's not the gun, it's the mental illness!", if that is a sincere thought, it's funny that Repubs, even ones in the NRA lobby pocket, are not addressing this issue.

Congressmen who make this SAME mental health rejoinder in support of gun rights, are the very ones voting to reduce access to affordable mental healthcare.

[Zaxxon]

In the wake of yet another mass shooting, you would think that some on the right would be pushing hard for increased healthcare, if only mental.

No.

[Carpet_pissr]

I can't bring myself to type "Ha!" in response to that as I would normally. The 'sad' to 'true' ratio is too high.

[Chaz]

There won't be a push for either mental health care or gun restrictions. Mental health care might help too many poor people (who should be helping themselves), and gun restrictions loses you too many votes.

[Carpet_pissr]

Thoughts and prayers it is, then.

[Zaxxon]

[Chaz]

Thoughts and prayers it is, then.

In my head, I translate "thoughts and prayers" into "people died, but wouldn't it be so much worse if people weren't able to own as many guns as they want?"

[Isgrimnur]

The Care Bear Stare actually had an impact.

[Max Peck]

The Care Bear Stare actually had an impact.

Also, the Care Bears actually cared.

[Isgrimnur]

The Care Bear Stare actually had an impact.

Also, the Care Bears actually cared.

Point.