Monthly Archives: July 2012

Back in the Saddle

So, the holidays are over, the Supremes have spoken and the backlash is started. So, I guess I should finish this thing.

Section 1323 of the PPACA gives money to the territories to help them enact the provisions of the PPACA. Puerto Rico (remember them) gets $925,000,000; and all the other territories get to split $75,000,000.

Section 1324 is entitled “Level Playing Field“. I don’t think they are talking about baseball, or cricket though. What is does say is that if a state offered plan is exempted from a law, then the privately offered plans in that state must also be exempted from the law. These exemptions are mostly in the areas of renewals, ratings, preexisting conditions, non-discrimination, etc. Presumably, this will maintain competition for privately offered plans.

Section 1331 gives states the right to establish different health care programs for lower income, but not eligible for Medicaid, individuals. These plans cannot cost more than an individual would pay for private insurance. The plans must also be competitively bid out to those who would provide the health care. One interesting point about these alternative plans is that people who participate in them cannot also purchase insurance through an Exchange. Presumable, this is to prevent double paying, or other cost increasing tactics.

Section 1332 gives states the right to do better. They can be waived from all requirements of the PPACA if they provide as much coverage as, without being more expensive than, and cover as many people as the PPACA, without increasing the Federal deficit (i.e., just giving everyone Medicaid). So, get out there and innovate, states!

Section 1333 deals with the sticky wicket that is the fact that insurance is typically sold on a state basis, and not a national one. Insurance plans can offer themselves in more than one state, but they have to be subject to any individual state laws that deal with insurance. These “compacts” as they are called here cannot be offered before 2016.

Section 1334 discusses multi-state health plans. These appear to be mostly the plans that will be offered in the exchanges, and requires that there be at least two such plans available through the Exchanges. States can increase the health coverage offered through these plans, at their own cost.

The next sections deal with reinsurance, and risk adjustment, so will probably take some more explaining.

Welcome back to the PPACA!


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