CRTGAMER wrote:Getting rid of the state monopolies and instead the nation wide insurance choice should have some affect on reducing costs, competition always a good thing.
This would not fix things the way you seem to think it would.
The trouble is that varying or numerous state regulations aren’t the main reason insurance markets tend to be uncompetitive. Selling insurance in a new region or state takes more than just getting a license and including all the locally required benefits. It also involves setting up favorable contracts with doctors and hospitals so that customers will be able to get access to health care. Establishing those networks of health care providers can be hard for new market entrants.
“The barriers to entry are not truly regulatory, they are financial and they are network,” said Sabrina Corlette, the director of the Georgetown University Health Policy Institute. In 2012, Ms. Corlette and co-authors completed a study of a number of states that passed laws to allow out-of-state insurance sales. Not a single out-of-state insurer had taken them up on the offer. As Ms. Corlette’s paper highlighted, there is no federal impediment to across-state-lines arrangements. The main difficulty is that most states want to regulate local products themselves. The Affordable Care Act actually has a few provisions to encourage more regional and national sales of insurance, but they have not proved popular.
Insurers have been muted in their enthusiasm for G.O.P. across-state-lines plans. Neither America’s Health Insurance Plans, the lobbying group for most private insurers, nor the Blue Cross Blue Shield Association have endorsed such a plan when it has come before Congress.
https://www.nytimes.com/2015/09/01/upshot/the-problem-with-gop-plans-to-sell-health-insurance-across-state-lines.html?_r=0
Basically, the insurance across state lines issue is a non-starter. Even where there is uniformity in Federal law, like with Medicare, companies simply don't want to venture into new territory. They don't want to compete. The ACA already tried to make them and they resisted.
It was mentioned a Catastrophe Health Care option perfect for younger people who statistically are more healthy and on a tighter income; that looks like a much better viable option. Pay your own way for routine clinic visits and medication and have the coverage for just serious injuries. Why was this not done initially?!
Because economically it's a bad idea. Insurers can encourage good health behavior by subsidizing regular checkups, and that good behavior reduces catastrophic events. Companies can also recoup costs by up-charging generics. Depending on the generic drug, it can be cheaper to purchase without a prescription at Walmart or CVS rather than going through the insurers pharmacy plan. Most people don't think twice about the fact that they paid $20 for a 90-day generic instead of $12, and that does help insurers recoup costs.
Catastrophic-only coverage would therefore not necessarily be any cheaper for the insured, because it would remove any ability at all of insurers to reduce risk in their insured pool or recoup costs. And if the ACA eliminates protections for those with pre-existing conditions or removes the prohibition on maximum benefit caps, catastrophic-only coverage would become a dangerous space to be a consumer in, because companies would do their damnedest to make sure your insurance contract cuts you off once you become a liability, or simply excludes the riskiest cohorts, ensuring the millions will fall back into the ranks of the uninsured, putting further pressure on emergency rooms and hospitals.
And if catastrophic-only isn't significantly cheaper, then people will simply not get preventive care because they won't be able to afford it out of pocket. And people with persistent conditions like diabetes will therefore not have medical attention until a catastrophic event. They'll be in and out of the emergency room with no preventive care in-between, which is the exact same model as those who are uninsured, and if you're going to do that, why bother to get insurance anyway?
