The Affordable Care Act/Obamacare - A State's Rights Issue?Submitted by Chris Madcowski on Thu, 09/26/2013 - 18:50
After all these months and years of debate over Obamacare, I'm not sure if I've heard anyone get into the fact that health insurance regulation has been, up until now, a privilege of each individual state, to mandate and forbid as they choose under the 10th amendment.
In 1998 and '99 I worked for a worked as a claims customer service representative for a health insurance company that dealt primarily with PPO (Preferred Provider Organization) plans for group policy holders, though they did also administrate some self-funded policies for groups and individuals.
The company sold policies in 23 states. My team handled calls from 12 states, and I occasionally talked to people from most of the 11 states - which were divided between two other teams - as well.
The reason why we were divided into groups of 12, 6, and 5 states per group was because of the different regulations and requirements demanded by each state of any insurance company that wished to do business there. The 12 states on my roster were the 12 easiest because the state mandates were most similar.
The other 11 states were the ones with special added-on requirements - coverage for children up to age 21, common law marriage, dependent daughter pregnancy, chiropractic, innoculations, mental health.
The last one - mental health - was mandated at the time by Maryland. Though several other states in the union had mandates for mental health at that early date, it was the only one of the 23 states of 50 (or is it 57?) that we sold policies in that did this. (At the time I thought it was the only one in the union because it contained Washington DC, but I've turned out to be incorrect on that).
The mandate is: Benefits for treatment of mental illnesses, emotional disorders, and drug and alcohol abuse for group or individual, Eff. October 1, 1997 http://www.ncsl.org/issues-research/health/mental-health-ben...
It is a state mandate - something the state legislature voted on, presented I'm sure as a 'protection' for its citizens. Whether this or any other mandate is 'good' or 'bad', it had definite consequences.
First - from what I saw directly - it drove the price of policies up dramatically.
Second - what I can only infer - it altered peoples decisions on which state to live in. If a DC/Maryland worker wanted to save substantially on health insurance they could choose to live in one of the surrounding states with no such coverage requirements for individual policy holders at the time - West Virginia, Virginia, or Pennsylvania. The fourth bordering state, Deleware, had only that year, in January of '99, passed a mandate for severe mental illness coverage -ST TI 18 § 3578; ST TI 18 § 3343.
Aside from this single example of mental health coverage, the other mandates raise similar examples of how health insurance used to be a state's rights issue, but under Obamacare apparently will be no longer.
From my limited perspective that year at the insurance company Obamacare violates states rights, and needs to be dismantled at the state level. Every requirement, every allowance, every disallowance, needs to be debated by the state legislatures and voted on in a proper and orderly fashion.
Rights not used are rights abused. The states need to stand up for themselves.