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Interstate health insurance myths

The game played by politicians is to take an idea from their own agenda and then frame it in a way that sells it to the other side. When the politicians meet in the middle, bipartisan solutions to problems emerge. This reflects the fact there is no monopoly on good ideas, only simple good solutions to difficult problems. In the healthcare debate, one of the solutions proposed by the GOP was to allow people to buy their insurance across state lines. This sounds a good idea. As the law stands, every state regulates the sale of insurance within its own borders. This limits the size of the market. If insurers had to compete with each other on a regional or national level, the premium rates would fall and every citizen would get a better deal. Well, let’s look a little more closely at how it would actually work.

At present, every state has a Department of Insurance to regulate the insurance companies licensed to sell policies. This is a reasonably effective system for consumer protection. But if regional or national insurers could sell policies into many states, it would break the regulatory system. It would no longer be local supervision of local companies. Insurers would decide where to establish and would, of course, choose the states which had the weakest consumer protection regulations, i.e. where they could make the most profit. Think banks and finance companies. These companies broke the US economy and produced the recession because their sales of subprime mortgages and associated derivatives were unregulated. Now apply the same thing to interstate insurance. As a final thought on this issue, remember all US states have different laws and one state cannot enforce another’s laws. That is sovereignty for you. So the state where an insurer is based cannot protect consumers under another state’s laws.

Secondly, opening the market across state lines allows insurers to cherry pick the best people to insure. Without regulations to limit the right to discriminate against people for pre-existing conditions and to increase premiums as people get older and fall ill more often, insurers will just take their profit from all the healthy people and forget about the rest. Thus, instead of increasing consumer choice, it would have the reverse effect. Most insurance companies would close their branches in individual states. Those that remained would keep all the aging and less healthy people. As their claims rise, the companies will make a loss and close. Without a law to mandate regional or national companies to offer some health coverage, it is likely the number of uninsured people would rise.

When you add all this up, it is a good thing the GOP’s proposal was rejected. Health insurance plans are complicated enough without having to change a whole mass of federal and state laws to allow interstate sales. This is not to say that consumers might benefit if there was more competition in the insurance market generally. With a real free market, properly regulated, consumers would get a better deal both in the terms of coverage and in the premium rates they pay. As it is, you must get multiple quotes to find cheap health insurance. Anticipating their profits will take a hit following this reform, insurers have been raising their premium rates. You must shop around to find the most affordable policy.

Let’s buy health insurance plans across state lines

Let’s leave the politics of healthcare reform to one side and focus on a proposal to change the law to allow free market competition between insurers in different states. A policy consistently mentioned by the Republican party is to break the state monopolies in the insurance market. Since the 1800′s, the individual states have claimed the sole right to regulate the sale of insurance within their own borders. Each state has asserted the right to license insurance companies and to set the terms on which they can conduct business. This has led to a patchwork of different sets of regulations with each state creating unique laws. In turn, this forces an insurance company to set up separate subsidiaries to trade in each state. No licensed company can sell a policy to someone who has a residence in another state. There was a brief moment in 1944 when a decision of the Supreme Court allowed the possibility of federal supervision. But the lawmakers in Washington immediately changed the law to retain state control. Why is this a bad thing? The national insurance companies have divided up the states between them and choose not to compete against each other. This keeps the number of insurance companies in each state artificially low and, because there is no real competition, premium rates are higher than they should be for weak policy terms.

You are reading this article on the internet. When online, you can buy more or less any product or service across state or national boundaries. Although there are some restrictions, e.g. some states limit your right to import drugs from foreign countries, there is an almost free market where you can search for the cheapest price and buy whatever you need. There is no possible economic justification for retaining this historical privilege for insurance companies. All it does is preserve their ability to maximize their profits at your expense. For example, in Minnesota three insurance companies dominate 80% of the market for health plans. There is no doubt that, if more companies entered the market, the premium rates would fall. During his run for President, Senator John McCain was in favor of free markets for health plans. President Obama supports it and the proposal is in both versions of the healthcare reform bills currently stalled in Washington. But because the Republican party’s only policy is to oppose everything the Democrats propose, it seems even this simple change in the law may be lost. What will the result be? The anticompetitive behavior of the insurance industry will continue and you, the consumer, will suffer.

Could the law change tomorrow and allow everyone access to cheap health insurance wherever it can be found? The problem is that the states have different sets of regulations and compliance leads to different costs. The playing fields are not level. So, premiums are significantly lower in those states which have the fewest consumer protections. It would not be fair competition if people living in Minnesota, which has strong consumer protections, could all get health insurance quotes from states with little or no consumer protections. The only way in which there could be a free market is to have a single set of federal regulations for the sale of health insurance plans. Sadly, the political parties do not want to talk about this even though we would all benefit. In the US, the political elite’s interests do not match the needs of the ordinary citizens.