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It isn't a red herring per two health economy experts here in Minnesota. And it makes sense that it would drive competition. The largest issue with the concept is the time it would take to develop the broader marketplace. It would take several years to really develop that market. But then again, it would be wiser with any endeavor like this to let things develop more slowly so we see what works well. A lesson folks are learning with Obamacare - Diane Feinstein being the latest to support legislation to allow people to keep their existing coverage.
 
It isn't a red herring per two health economy experts here in Minnesota. And it makes sense that it would drive competition. The largest issue with the concept is the time it would take to develop the broader marketplace. It would take several years to really develop that market. But then again, it would be wiser with any endeavor like this to let things develop more slowly so we see what works well. A lesson folks are learning with Obamacare - Diane Feinstein being the latest to support legislation to allow people to keep their existing coverage.

Im still lost at what carriers dont sell across state lines today? United? Aetna? Cigna? Humana? Coventry? The Blues?

So, is this a play at getting local/medium sized carriers to go into other states? I just don't understand the argument other than "more competition means lower prices".
 
Im still lost at what carriers dont sell across state lines today? United? Aetna? Cigna? Humana? Coventry? The Blues?

So, is this a play at getting local/medium sized carriers to go into other states? I just don't understand the argument other than "more competition means lower prices".

None of them truly sell across state lines today - as you already know. Blue MN can't sell in WI and Blue WI can't sell in MN. So as a consumer you receive fewer choices. And more competition means not only lower prices but also more choices. That is a better outcome than what Obamacare is delivering which is fewer choices and often significantly higher prices across much of the country (outlined above).

This law merely redistributes who pays for the costs of care. You can't charge a really old unhealthy person more than 3x what you charge a young person. So if today you charge 800 to the old guy and 100 to the young guy, come January 1st you'll charge the young guy 225 and the old guy 675. And the young guy, who may not drink and certainly isn't having babies, will have coverage for things he doesn't consume. You hear people proclaim that we all have to pay for each other as one of the defenses for the act. OK. Guess what? That is already happening today anyway. This just mandates how that get's paid. You, the young healthy guy, must pay more for Mary, the baby boomer with type 2 diabetes.
 
None of them truly sell across state lines today - as you already know. Blue MN can't sell in WI and Blue WI can't sell in MN. So as a consumer you receive fewer choices. And more competition means not only lower prices but also more choices. That is a better outcome than what Obamacare is delivering which is fewer choices and often significantly higher prices across much of the country (outlined above).

This law merely redistributes who pays for the costs of care. You can't charge a really old unhealthy person more than 3x what you charge a young person. So if today you charge 800 to the old guy and 100 to the young guy, come January 1st you'll charge the young guy 225 and the old guy 675. And the young guy, who may not drink and certainly isn't having babies, will have coverage for things he doesn't consume. You hear people proclaim that we all have to pay for each other as one of the defenses for the act. OK. Guess what? That is already happening today anyway. This just mandates how that get's paid. You, the young healthy guy, must pay more for Mary, the baby boomer with type 2 diabetes.

I get the technicality but still stand by the statement that the nationals all compete in most states and selling across state lines wont in itself do much. FWIW, Blue plans can compete across state lines, just not with their names which has a lot more to do with their franchise rules than any federal rule. Plus, Blues plans share networks so

In the pre-ACA days, the advantages of this were obvious...go to the state with the fewest regs/mandates and then sell those products. The ACA changes that and leaves us with a very level playing field. Folks just dont realize how much variability there is in medical expense across states (heck even within a state) for a host of reasons. Competition of payers wont change that. Im all for competition but this isn't the panacea we think it is. Competition will force payors and providers to be more innovative. Plus, we already have a capped MLR floor so their aren't excess profits here.

I still cite NC as an example. 10 carriers off exchange whose pricing looks a whole lot like the pricing of the 2 carriers on exchange.
 
I get the technicality but still stand by the statement that the nationals all compete in most states and selling across state lines wont in itself do much. FWIW, Blue plans can compete across state lines, just not with their names which has a lot more to do with their franchise rules than any federal rule. Plus, Blues plans share networks so

In the pre-ACA days, the advantages of this were obvious...go to the state with the fewest regs/mandates and then sell those products. The ACA changes that and leaves us with a very level playing field. Folks just dont realize how much variability there is in medical expense across states (heck even within a state) for a host of reasons. Competition of payers wont change that. Im all for competition but this isn't the panacea we think it is. Competition will force payors and providers to be more innovative. Plus, we already have a capped MLR floor so their aren't excess profits here.

I still cite NC as an example. 10 carriers off exchange whose pricing looks a whole lot like the pricing of the 2 carriers on exchange.

Of course there is variability within individual states. That is the case with many types of markets. It costs more to drive and maintain a car here than in rural Kansas. And you'll get priced accordingly. And with insurance individual states regulate it differently. Permitting broader competition would mean better pricing though. That is basic economics no matter how much you want to argue to the contrary. And let's not pretend there won't still be regulation - it would require Federal regulation to even create such a system effectively given the current landscape.

In today's news cancer patients are seeing doctors kicked out of their provider networks under the ACA and are paying enormously higher out of pocket expenses to get their care. Why? Because all the mandates on coverage and pricing are putting insurance companies in the position of squeezing their provider networks. So they create plans that technically meet the law but offer fewer choices. Another poorly thought out consequence. Another reason why reforms this massive should be done slowly.

The other item of note today - the web site won't be running by December 1st. I don't think that is news. Diane Feinstein wouldn't have sounded off yesterday without some sense that thing won't get solved timely. http://www.washingtonpost.com/natio...f9670a-4bca-11e3-be6b-d3d28122e6d4_print.html
 
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As someone real close to this, I just don't agree that it will be meaningful, despite the academic argument. I've spent a lot of time of this very subject and its just not what you think when it comes down to implementation. And the reality is its not going to happen as its being positioned. Plus, as I said, it largely is already indirectly happening with the large nationals. Still trying to understand why we don't see lower prices in NC with 10 carriers. But a conversation for another day.

I think a lot of people saw limited networks coming for exchange products. Many states do have more broad networks, just at a higher cost. I certainly understand the issue here and its terrible when it happens. Hopefully, these folks can find plans with the docs they want. But hey, if you like you doc, you can keep your doc...
 
Competing across state lines sounds like a good idea until you actually think about what would happen.

The first thing that would happen is most states (that aren't already) would become virtual monopolies. The big boys would immediately start buying up all the regional carriers. Rates would go up dramatically due to this.

The next, and maybe more devastating, result would be insurance companies would do just like the credit card companies have done. They would set up their HQs in states that have the laxest regulations about pricing and consumer rights. Just like your state may have laws about interest rates and other rights for credit cards purchased in your state but can't control cards issued in South Dakota or other places, the same thing would happen in health insurance. You may live in NC, but your insurance purchase would happen from a state with less consumer protections, rate scales and even less ability to remedy any problems that arise from negative actions by your doctor and especially by your insurance company.

The people who will most benefit by "buying across state lines" are the insurance companies. Customers will be dramatically harmed. Anyone who says the purpose of this scam is to help consumers is intentionally lying to you.
 
Anyone who says the purpose of this scam is to help consumers is intentionally lying to you.

Interesting choice of words given the blatant lie about keeping your insurance that the president kept repeating.
 
Competing across state lines sounds like a good idea until you actually think about what would happen.

The first thing that would happen is most states (that aren't already) would become virtual monopolies. The big boys would immediately start buying up all the regional carriers. Rates would go up dramatically due to this.

The next, and maybe more devastating, result would be insurance companies would do just like the credit card companies have done. They would set up their HQs in states that have the laxest regulations about pricing and consumer rights. Just like your state may have laws about interest rates and other rights for credit cards purchased in your state but can't control cards issued in South Dakota or other places, the same thing would happen in health insurance. You may live in NC, but your insurance purchase would happen from a state with less consumer protections, rate scales and even less ability to remedy any problems that arise from negative actions by your doctor and especially by your insurance company.

The people who will most benefit by "buying across state lines" are the insurance companies. Customers will be dramatically harmed. Anyone who says the purpose of this scam is to help consumers is intentionally lying to you.


Pretty much the opposite of this is true.

1. Insurers buy smaller carriers now to get access to new markets/segments. Selling across state lines would eliminate this need.

2. Pretty much all the regs are set by HHS and the ACA. Very little opportunity here any more.

3. I work for an insurance company and think this is a terrible idea and most of us do.

3-3.
 
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Arkansas - of all places - managed to come up with a way to accept Medicaid expansion with a 75% Republican legislature, by getting an exception to convert the Federal Medicaid dollars into grants for the poor to buy private insurance. http://www.theatlantic.com/health/archive/2013/11/the-state-where-obamacare-is-working/281411/

I hope more states follow Arkansas' lead. The goal here is to get more people insured, and the GOP states rejecting Medicaid are probably the single biggest obstacle to achieving the goal.
 
Arkansas - of all places - managed to come up with a way to accept Medicaid expansion with a 75% Republican legislature, by getting an exception to convert the Federal Medicaid dollars into grants for the poor to buy private insurance. http://www.theatlantic.com/health/archive/2013/11/the-state-where-obamacare-is-working/281411/

I hope more states follow Arkansas' lead. The goal here is to get more people insured, and the GOP states rejecting Medicaid are probably the single biggest obstacle to achieving the goal.

One of three objectives - the other two being reform insurance (evidently that's code for juicing insurance company market caps by increasing their addressable markets) and reduce health costs (not clear what policies are addressing that).
 
I voted for Dole over Hagan last time around. But Hagan will probably get my vote this (next) time.

Pubs posturing over the ACA is partly why...
 
Americans may be able to keep their individual insurance plans for one more year, under a fix offered by President Obama on Thursday to address a controversial provision of the Affordable Care Act.

http://money.cnn.com/2013/11/14/news/economy/obamacare-insurance/index.html?hpt=hp_t1

How on earth do you implement this? So many policies have already been cancelled. As one commenter in this article puts it, this is like trying to put the toothpaste back in the tube. I can't imagine insurers are prepared to turn these plans back on. Doesn't look like they're being forced to, so I wonder if this really changes anything or is just a half-assed attempt to save face.
 
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