Insurance companies pool across state lines all the time, it's legal so long as the benefit plan meets the mandates of each state.
As I've mentioned in other threads, this medicare part E idea you have is a bad idea. The rates would be gigantically high if you are pooling together a group of people that is comprised entirely of sick people. This pretty much violates rule number one in group health insurance risk selection. You want a good mix of healthy people in the group to subsidize the sick. I also disagree with your idea in principal, because it would create a system of haves and have not. The sick would have extremely expensive coverage and the healthy would have cheap plans. The last thing people should have to worry about when they're sick is going bankrupt too. Under your proposed policy that is exactly what would happen. When the insurers are pricing out health plans they don't price every single plan with the assumption that everyone will get pregnant. They most likely look at the share of the population that is child bearing age and find some average rate of pregnancy in their tables. This is kind of like saying "I dont have cancer...why do I need cancer coverage??" health insurance is fundamentally a re-distributive product. In most groups 80 % of the population funds 20 % of the population.
Nope. Large insurance companies have franchises in many States but for private insurance, cannot be sold across State lines, have different actuarial costs, and contain the only State risk pool. One of the arguments has been to allow interstate sales of health insurance to lower cost. Private insurers are not limited.
The number one reason the Dems and President passed the PPACA was to, in their words, provide insurance to those with pre-existing conditions that were denied insurance by Private Insurance Companies. Their solution, require all private insurance companies to insure those with pre-existing conditions but no addressing the implications including the additional cost of providing insurance to these individuals and the resulting higher premiums to those not having pre-existing conditions. That is why I believe these individuals should be separated from individuals covered by private insurance and instead they should be pooled together under a Government Plan. Doing it under Medicare would be easy and less costly as as they infrastrtucture is already in place. That was accomplished but the ACA didn't regulate the premium that those with pre-existing conditions could be charged. Their solution, was to provide lower cost health insurance through exchanges and with subsidies to help these individuals pay the premium when they qualified for such. Unfortunately, these plans are charging higher premiums for these individuals, higher deductibles, higher out of pocket and co-payments vs. those without pre-exisiting conditions, offering plans with fewer physician in network providers and hospitals and making insureds and providers jump through hoops to be reimbursed for the services even when they are in network. that is an undisputable fact. And that is based on what my patients and I are experiencing. The mainstream media doesn't use actual, real-time facts when they report on the ACA. They use data from biased and government funded reports conducted by those that don't actually provide patient care or information from provided by patients regarding their problems using ACA Exchange Insurance Plans. All of the insurance companies providing plans through the exchange also provide plans for purchase outside of the exchanges. And these Companies have contacted all of their current in network providers and have told them/us that if we sign on to these exchange plans we can expect reimbursements either equal to or lower than Medicare/Medicaid reimbursements rates. Therefore, many providers didn't sign on to these plans. In regard to your comments on the "minimum essential benefits", not voted on by Congress or included in the ACA but left solely up to the discretion of HHS; requiring post menopause couples to pay for the most costly of all insurance benefits; maternity and newborn care, is nothing less than comical. What consequences could they face. Unless through an act of god they have no chance of getting pregnant. Period. And, additionally, if the individual purchasing insurance is a single male or female, why should they be forced to pay for maternity or newborn care coverage? We the taxpayer are already paying for them to have free contraceptive care. So, for one, my comments are not opinions but facts based on the daily medical/surgical care millions receive on a daily basis. Not a study but real-time facts. And no one should be forced to pay higher premiums because they must have benefits they will never need and unless through an act of God will never use. It is just one of hidden (according to SCOTUS) taxes within the ACA that we were never told about prior to passage of ACA. Those without extensive experience and knowledge gained through daily experience in the health care field may find it necessary to read the results of studies conducted by those in Academia, those that work in the field know what is true and what is not as we observe it every day. So claiming I am commenting not factually but based solely on opinion is simply a false statement. It is up to you to dispute what I say and prove it false. Good luck with that. I am an expert in my field.
That's not true. I have a family member who works for eBay in Nebraska. My family member has insurance through blue cross of California because Blue cross of California has pooled across state lines into Nebraska.
The premise of your idea is a good one. Grouping insured's into larger Insurance pools definitely brings down the cost of premiums and the cost of insurance companies insuring the pool. That is why the PPACA should have grouped the uninsurable/those with costly pre-existing conditions together, into one pool, IMO under another part of Medicare would have been the easiest solution.
Grouping all those with expensive pre-existing conditions is going to bring down their costs of premiums. This must be another of your expert, and obviously incorrect, opinions. And of course putting this group into a separate pool under another part of Medicare seems totally nonsensical. Medicare is a pool not a group of individual pools. Perhaps you were actually thinking about Medicade and got confused.
Can you find me any article stating that fully insured groups can't purchase insurance across state lines? Every article I read it pertains to individuals
It's Federal law, McCarran-Ferguson Act (1945), and still is. Look it up. It does not apply to self insured companies.
I googled for a while and here's what I found pertaining to group insurance: http://www.huffingtonpost.com/rep-eddie-bernice-johnson/eliminate-the-antitrust-e_b_474769.html This confirms my suspicions that the restrictions pertaining to purchasing insurance across state lines applies solely to individuals.
The state of Indiana had some plan people could buy into but I don't know the details other than some said it was horrible and some said it was great. Universal healhcare is the only way to improve upon the mess we are in now. Almost like they intended that.
That's very similar to the Canadian system. Usually, with employer provided group policies, the only premium charged to the employee is the diability/life insurance portion and that is strictly for tax purposes (if the employee pays for these those benefits are tax free, if the employer pays the benefits are taxable). Private health insurance acts as a supplement to the universal healthcare extended to ALL citizens. In Canada, universal healthcare covers about 70% of all direct medical expenses (sans some medications drugs).
And that's actually somewhat similar to the American system of Medicare Supplement for seniors. Medicare covers about half of all seniors health care charges. Supplement picks up the rest.
I'm paying $920 per year health insurance organised by my employer as a group policy. I'm covered for 1 million dollars per year. Included is full medical and hospital, accidental dental, medi evacuation back to Australia and ambulance. It even covers my remains taken home if worse comes to worse. This covers me worldwide, even if I'm back in Australia. This policy has been designed for professionals working abroad. Interestingly, this policy doesn't cover me in America (wonder why?). I've had to use it only once. I spent four days in a Thai hospital with a kidney infection and kidney stones. My first ever stay in hospital. All I needed to do was scan the hospital's accounts, supply the hospital's details, give my bank account details then email everything to the insurance company. I was fully refunded within a fortnight. I even received an email wishing me good health and continued service. Besides ambulance, this is the first time in my life (I'm in my late 50s) I've had private health insurance.
As an American, that all sounds pretty amazing to me, except the annual cap, which isn't a huge deal, but it is a tad surprising to me that you have an annual cap.
Self-insured plans (which the majority of folks with employer-based health insurance are in) are a different animal. Nobody's buying an insurance product from a health insurer or paying an insurer a premium when it comes to those plans; they're buying administrative functions and access to a certain provider network at a health insurers' negotiated rates. Those plans aren't subject to state benefit mandates, state regulations, any of that. The employer is the insurer and takes on the risk of paying employees' health expenses. That's what most privately insured people have. The minority of folks who have fully insured plans (either purchased on their own or by their--usually small--employer on their behalf) are in a different boat. They are buying an insurance product from an insurance company. Those plans are subject to state regulations and states--even very red states--have generally not been eager to share jurisdiction or responsibility over those plans with other states, even though they could do so if they wished. That said, unless one is in a very tiny state the issue isn't likely to be an insufficiently large risk pool. So this stuff about needing more interstate risk pools is generally a little bit of a red herring (historically in pursuit of a broader deregulatory agenda). You don't even want to guess what that plan would be charged if it were usable in the U.S. And clearly neither do your benefit administrators.
There are a number (most?) of self insured plans that have stop loss insurance products on them. That would seem to be an insurance product, and I'm thinking those are pooled across state lines. I'm aware of an insurance carrier that pools fully insured products across state lines. Maybe large group fully insured products aren't subjected to this regulation.
Stop-loss insurance generally isn't treated like health insurance under state law. Are you sure you're talking about a fully insured plan? Most large employer plans are not, though their employees may or may not be aware they're actually in a self-insured plan.
How about just letting each individual and family choose the coverage they want and pay for only that coverage? Seems pretty simple to me.
I can well image. A couple of American work colleagues asked that question if they return home for a few weeks. No one was willing to give an answer not even the insurance company's representative who was conducting a meeting at the time. I've never seen so many p!ssed off Americans in the one place.
Because then you have to decide what to do if medical care is required outside of he chosen coverage.
In other words the powers in charge think I am too dumb to know what I need or what my family needs. That I have to be told exactly what I need by the powers in Washington that never met me or haven't the slightest idea of the health conditions of me and my family, our status and everything else.
Most large corporations do run their own plans. The buy them from insurance companies based on a series of benefits they want to buy. Many of these groups are self funded. In other words, the company supplies the money and the insurance company merely administers the plan. No it doesn't. The ACA is broken down into many small groups. They write in multiple states but separate group plans. The pool is at the group level. Each group is it's own pool. That's how insurance is sold. You seem to know about as much about health insurance as Obama does.
