I just want to note one fly in the ointment that hasn't gotten a lot of press, in terms of the national insurance market. My concern is that sooner or later the Supreme Court will put us in the same situation we are with credit cards today: that the laws of the incorporating state of the issuer govern all aspects of the contract.

It is my understanding that, at least prior to the adoption of national legislation, that may not be entirely true in the case of "surplus lines" from "non-admitted carriers," as a general proposition. By example, see links to the following web pages of The Surplus Line Association of California:

"Non-Admitted Does Not Mean Non-Regulated" http://www.sla-cal.org/publications/pb_nonadmitted.html

and "Don't Worry -- Non-admitted Does Not Mean Non-regulated" http://www.sla-cal.org/publications/...doesntmean.pdf

But how this works now out in practice is another thing indeed. See, eGlobalHealth Insurers Agency, LLC, "Differences between Admitted U.S. Insurance & Surplus Lines International Medical Insurance Programs & What it means to you" at http://www.eglobalhealth.com/Pre-exi...formation.html and in particular, the following:

. . . Admitted policies are approved by U.S. regulators and the policy definitions & contract wording need to conform to strict standards set forth by U.S. regulators, state by state (there are a few states in the US -- ie; NY for one -- that are very strict and may not even allow certain US insurance companies to provide insurance in that particular state). Non-admitted carriers (ie; Surplus Lines like Lloyds of London, etc) are not required to follow any particular US or State regulations. One case in point, the Pre-existing language can be very different between an Admitted and Surplus Lines health insurance program. As a result, admitted wording tends to be more consumer friendly. Even though you may very well pay more for an admitted plan, it could end up being that you could, in certain circumstances, pay more in the long run, especially if you thought your pre-existing ailment or condition would be covered under your plan and it turns out it is excluded due to specific language or exclusionary riders placed on the policy prior to your acceptance in the program.

And note well: a "non-admitted carrier" doesn't have to be from overseas, it can just be from another state and has chosen not to be licensed as an "admitted carrier." where you live. Thereby exempting itself from a substantial part from your state's insurance regulation.

So, is there is any specific language in the legislation pertaining to the right of an individual state to regulate health insurance purchased in the "national market place" created by Healthcare Reform (whatever its formal title) or whether, merely through the creation of a national insurance market as a creature of federal statute, that alone may be seen as an "occupation of the field" pre-empting the laws and regulations of any state except that in which the carrier is domiciled?

In this regard, we are guided by the Supreme Court's decision in Marquette Nat. Bank of Minneapolis v. First of Omaha Service Corp. (439 U.S. 299), a unanimous 1978 decision holding that state anti-usury laws regulating interest rates cannot be enforced against nationally-chartered banks based in other states. In that opinion Justice William Brennan (of all people) wrote that it was clearly the intent of Congress when it passed the National Banking Act that nationally-chartered banks would be subject only to federal regulation by the Comptroller of Currency and the laws of the state in which they were chartered, and that only Congress or the appropriate state legislature could pass the laws regulating them. Full text of opinion at: http://caselaw.lp.findlaw.com/cgi-bi...=439&invol=299

And from which followed the "race to the bottom" to see which states would offer the least demanding set of regulation, including the de facto abolition of usury laws.

So the question becomes what "intent" - with respect to the ability of individual states to regulate the health insurance sold within its borders - will be found in the present legislation? If anyone has an understanding of the legislation on this point, I would love to know about it.

Mike

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

If you go to FoxNews.com and go down to roll call you will see which reps in your state voted for the healthcare. Run off a copy and save it for Nov. Since RSD patients have short term memories this will be a reminder. It goes on my wall until Nov. Least we forget.

I did hear this morning that the pre-existing condition part won't go into effect until 2014 after hearing a Democrat say yesterday it starts imediately.
If nothing else, the whole thing is confusing.

Ada

After the president signs the bill and a companion bill is passed in the senate the pre-exist clause is over in 3 months. In six months children can stay on their parents policy upto 26 years old. One thing I did hear differently pertaining to the pre-existing condition clause is those folks, including my wife if she fails to acquire her SSDI, will be in a new high risk pool.

Both my grandson's are planning on going to college. I don't feel like my son-in-law should have to pay for their insurance until they are 26. What responsibility is that teaching them? He is their step-dad and he will do it I am sure and not complain once but it's not right. The way I understand this it's only if they go to college and it is mandated to where they have to carry the insurance, in other words they don't have a choice. So wrong.

Ada

I believe you are correct Ada. The reason I posted those parts of the bill is apparently it is these issues that will go into effect very quickly.

Jim -

It's my inderstanding that the bar against excluding children with pre-existing conditions will also take effect six months from either the date the Senate Bill or the date H.R.4872, the Reconciliation Act of 2010, is passed by the Senate and signed into law. (Not sure which, but believe it's the latter.) Which should be just in time for the mid-term elections.

I imagine there will be all sort of poster-children enrolled in that time period leading right up to the mid-terms, so that on the eve of the election, the Democrats can and will remind voters that any vote to repeal the legislation will be a vote to take back health insurance from those kids who will by then have it: a well played move, if I may say so. (Or you have to respect if even if you don't like it.)

Mike

I talked to my sister today. She has 2 daughters that are single Mom's and their kids are already on gov. insurance. It's called Medicaid. I am glad they are able to be on it for them. My thing is if we already have Medicaid, what have they got to brag about. More Medicaid. LOL

Ada

Check with the college's health center - often they have a bare bones insurance policy that the kids can purchase that's not too expensive.

However, once you have a family policy, it doesn't cost any add'l $$ to add another child. IMHO, it is far safer to keep your kid covered by health insurance until they get a job and can get their own coverage then risk financial disaster by not having any insurance at all. That feature is one of the few things I agree with in this whole fiasco.

Check out the polls on MSNBC.com and FoxNews.com. Close to 1,000,000 votes tallied so far - and more than 65% of voters on both sites are NOT in favor of Obamacare. Approx 25% are in favor. No one understands what was really passed - how many political favors or "pork" were buried in that bill?

Bummer. I feel like I've been had.

Ada -

The bill(s) offer significant low income subsidies to purchase "real insurance" that is much better than Medicaid. I believe the cut off line is 125% of the federal poverty line, but it may be higher in sime circumstances. That said, it's still not completely free, but it's going to be significantly more affordable.

This is by far the most expensive part of the legislation and is paid for by a 1% surcharge on those with an adgusted gross income between $350,000 and $500,000, 1.5% between $500,000 and a million, and 5.4% on the balance of AGI's over a million, effective January 1, 2011, with the 1% and 1.5% marginal rates to rise to 2% and 3%, respectively, effective January 1, 2013. [See, H.R. 4872, Reconciliation Act of 2010 (Reported in House), Sec. 441, SURCHARGE ON HIGH INCOME INDIVIDUALS, amending IRC Sec. 59, availabile at http://thomas.loc.gov by inputting "H.R. 4872" when prompted for "bill number."]

Now that's a tax incease! Except technically it's not, because the surcharges don't take effect if certain benchmarks for federal healthcare savings are met, based upon a complicated formula in the proposed statute.

So there's a reason the Republican Party doesn't like the bill, to say nothing of the requirement that employers with over 50 employees provide health insurance by 2014. Not a hit with the Chamber of Commerce either.

Mike