First of all, instead of a single national insurance exchange, as proposed in the House Bill, both the Senate Bill and the reconciliation version establishes 50 state-administered insurance marketplaces to allow small businesses and people without employer sponsored coverage to buy insurance that meets new federal standards.
http://www.aafp.org/online/en/home/p...ormpasses.html and
http://www.washingtonpost.com/wp-dyn...031905407.html
Turns out that until the language of the Reconciliation Bill was worked out, my concerns were well founded. Please see the following from the San Jose Mercury News:
National health reform could jeopardize California patient protections
By Mike Zapler
mzapler@mercurynews.com
Posted: 12/22/2009 04:20:03 PM PST
Updated: 12/22/2009 10:15:56 PM PST
WASHINGTON — A host of medical services that insurers must pay for in California — from cancer screenings to diabetes treatment to two-day hospital stays for delivering mothers — could be weakened or lost if the health care measures pending in Congress become law. Currently, any health insurer selling policies in California must comply with the state's extensive consumer protections. The reform measures would allow insurance firms to sell policies across state lines if certain conditions were met, bypassing California's rules in favor of the requirements in the state where the policy is issued. The result, critics warn, would be a "race to the bottom," in which insurance companies set up shop in states with the weakest consumer rights and skirt California's lengthy list of mandated health care services.
"This has the potential to wipe out all of these hard-fought protections," said Rep. Jackie Speier, D-San Mateo, who led the drive for several of those mandates as a state legislator earlier in her career and is now threatening to vote against a health care overhaul that weakens California's standards . . . .
http://www.mercurynews.com/breaking-news/ci_14051028
But, as it developed, it looks like I needn’t have worried:
H.R.4872
Reconciliation Act of 2010 (Reported in House)
------------------------------------------------------------------------------------------------
SEC. 151. RELATION TO OTHER REQUIREMENTS.
(a) Coverage Not Offered Through Exchange-
(1) IN GENERAL- In the case of health insurance coverage not offered through the Health Insurance Exchange (whether or not offered in connection with an employment-based health plan), and in the case of employment-based health plans, the requirements of this title do not supercede any requirements applicable under titles XXII and XXVII of the Public Health Service Act, parts 6 and 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, or State law, except insofar as such requirements prevent the application of a requirement of this subdivision, as determined by the Commissioner.
(2) CONSTRUCTION- Nothing in paragraph (1) shall be construed as affecting the application of section 514 of the Employee Retirement Income Security Act of 1974.
(b) Coverage Offered Through Exchange-
(1) IN GENERAL- In the case of health insurance coverage offered through the Health Insurance Exchange--
(A) the requirements of this title do not supercede any requirements (including requirements relating to genetic information nondiscrimination and mental health) applicable under title XXVII of the Public Health Service Act or under State law, except insofar as such requirements prevent the application of a requirement of this subdivision, as determined by the Commissioner; and
(B) individual rights and remedies under State laws shall apply.
(2) CONSTRUCTION- In the case of coverage described in paragraph (1), nothing in such paragraph shall be construed as preventing the application of rights and remedies under State laws with respect to any requirement referred to in paragraph (1)(A). [Emphasis added.]
http://thomas.loc.gov/cgi-bin/query/...5qPS:e1297986:
Accordingly, on passage of the Reconciliation Act of 2010 by recorded vote: 220 - 211 (Roll no. 167) at 11:36 pm on March 21, 2010, the House has apparently adopted language that shouts to the courts that, AS A GENERAL MATTER,
THERE WILL BE NO PREEMPTION OF STATE LAW, REGULATION AND REMIDIES, except as ERISA preemption already applies.
I'll take that.
Mike