Health law includes the relationship between the rights and responsibilities of patients, health care experts and to some extent the government. For many years, the health insurance policy in the US has been under the jurisdiction of individual states, but the latest developments have proposed for interstate health insurance policy. Interstate health insurance policy programs enhance better health care in different states, by providing free advice that is impartial on interstate health insurance for all those living in various states, provide a better opportunity to ensure equal rights are justified through actions of equal distribution of insurance health care to all people living and working across states.
There is a wide selection of various healthcare plans available within the US which could be of great benefit in protecting the policy holders and especially when needing assistance from the health insurance companies. Based on free consultation service, one should analyze the many healthcare plans in the market and then select one which completely suits his/her own circumstances. A clear understanding of the premiums paid is important before making a choice, and in some cases, it’s very important to have a benefit of choice and an impartial advice on various given health insurance plans to aid in selecting the right policy.
In the US, health care insurance policy has been instrumental in health care system. However, there has been asymmetrical benefit to the policy holders given that some states have higher cost insurance policies than others yet the policyholders are restricted to purchase the policy from their state of residence only. According to Pilzer (p. 236) the federal law of 1945 that prohibited the sale of policy across states has been very unfair to the residents of US and that the cost of the insurance policy will, among other factors, depend on the state one resides in. this paper will discuss the federal laws and constitutional barriers that would affect the proposed reforms in the health care and particularly the health insurance policy.
Proposed Health insurance policy
The general public has always identified healthcare as the key matter of concern. The federal government is always active in finding ways to make health care affordable to the general public and any reforms are always welcome. Any changes in the however, should be carefully vetted bearing in mind its implication to the social, economic and legal systems. Moreover, being a delicate subject, healthcare insurance policy reform is likely to encounter many obstacles especially on legal perspective as well as constitutional barriers.
Any form of federal legislation that intends to enact the Purchase of insurance policy Across State Lines (PASL) in any particular market of insurance will have to contend with two principle factors; the Mc Carran-Furguson Act which tries to ensure that the individual states maintain their regulatory autonomy over insurance so as to make independent decisions concerning their insurance procedures and constitution exclusion against the interference of state officials by the federal government.
There are various benefits that are likely to be realized from these reforms. For a long time the residents have had to contend with the limitation of purchasing the insurance policy from companies that are within their state. However, the interstate insurance policy will enhance competition as there will be integration of the insurance market leading to a reduction of health insurance costs. The overall effect will be affordability by all residents and improved public health and living standards (Sage para 1). The expected competition from deregulation of the states will allow the insurance companies to be innovative as each seeks to gain competitive advantage thus raising the quality of the health policy provided to the residents, the general effect of which will be the increase of social welfare.
Kanwit (p. 9) outlines the problems and potential measures that ought to be taken to avoid unnecessary misunderstandings once the legislation is well drafted. Two barriers to the reforms have been identified, one being the federal law (Mc Carran-Furguson Act) and the other being a constitutional prohibition barrier as discussed below.
Congressional Authority Under the Mc Carran –Ferguson Act
The federal Mc Carran –Ferguson Act tends to separate the federal law from interfering with the decisions relating to the health insurance by ensuring that the state retains its primary role of regulating issues of health insurance within its boundaries. However, in some cases, the federal government has the authority to block the state law taking precedence especially where the federal law has a specific bearing on a specific business of insurance (Kanwit 9). Although the proposal may face this constraint, it can as well escape the challenge by linking with the commerce clause power of the congress which will clear out the matter with the court and holding to the fact that the legislation relates to the business of insurance and therefore is preempted from the sate law.
Commandeering of state officials
The state officials are constitutionally bound to be independent from commandeering of the federal government on implementation of federal laws although through the Supreme Court the federal government can regulate interstate commerce, when only if the state officials are not required to alter their actions from so doing. The congress has a bigger role to play in the success of this legislation or reforms and to ensure everything goes well as peer the proposal, the congress has to clear out the matter that the PASL does not result to new duties for the state officials and incorporate the states participation in the reforms program through its spending power, which will ensure that there is little or no commandeering from the federal government
These involve the choice of model and measures to apply for levels of poverty subsidies and the mode of cost sharing to employ for preventive services. Some legal issues can be used to comprehensively analyze the current law in which case they must be clearly addressed to ensure the success of the reforms.
Although the states have been having description of regulation of the health plans, there are some exceptions especially where the health insurance plans involve group plans insured through state-funded insurance companies and in most cases those regulated by the Employee Retirement Income Security Act (ERISA), where uniformity is required. In addition, use of mandated benefits and access has not been fully implemented in states despite its importance especially in covering persons with particular diseases or health conditions. Moreover, the current regulatory regime of insurers may not be effective in solving disputes between the insured and insurers and therefore an external regulatory regime for review is important (Kanwit p. 17).
Due to the high cost of the insurance policy, there haven efforts by some states to enhance affordability through community rating where age-based ratings on premiums differentials are eliminated and also through guaranteed issue where there is no differentiation in terms of health status of the person.
Many state laws expect that some level of provision are provided for mental illness and they are not considered as total parity since they allow discrepancies in the levels of various benefits that may have been created by either mental or physical illness thus a call for purchase of insurance across state lines. Mental health services have been significant problem over the years; however, the costs coverage and availability of curing services has been the subject of policy discussions and various legislations. It is however, proposed that the harmonization of insurance industry across state lines will be a major step towards addressing of the cost issue in healthcare provision.
Ordinarily, where a state and federal law are in conflict the federal law is given a better opportunity to take over the state law. The Mc Carran –Ferguson Act stresses on the roles of the states as the most prime regulators of the insurance industry while preserving federal authority to manage insurance(Kanwit, 20). In the case whereby the congress wishes to preempt the state health law, then it can expressively declare that particular piece of legislation take priority over the state law.
The principle of state sovereignty of the constitution and the Tenth Amendment restricts the federal government from asking the states to implement policies that will deny the state its sovereignty powers. This bill of PASL is deemed to minimize the constitutional concern by making obligations of officials in the state to be consistent with the available and thus giving incentives by issuing funds. Matters should be cleared to ensure that there is proper understanding by all that the reforms are not bound to impose new responsibilities to the officials of the state but only a harmonization of legislation on purchase of policy. Moreover, due to the difference in the costs of policy in different states, and the fact that not all states are equally endowed, spending power of all states should be enhanced through provision of funds from the federal government. This will enhance not only the participation of the states in the interstate health insurance policy program, but also the lowering of the policy costs to make the premiums affordable to all federal residents.
Purchase of insurance Across State Lines can therefore be implemented, considering facts mentioned above and if addresses legal matters in respect to the principles already discussed above. McCarran –Ferguson concern can be addressed by carefully making the legislation with complete reference to the industry of insurance. Matters of commandeering of officials of the state should be minimized by drafting a constitution to stop state officials from being given more duties. Secondly in ways of providing of incentives inform of funds to various states so as to enhance and enforce state laws.Those who are responsible with making policies should learn to keep in mind the proposed measures above.policymakers may also be relevant to any federal government which comprises regulation of health in perspective of insurance.
Kanwit, Stephanie. “The Purchase of Insurance across State Lines in the Individual insurance Market.” O’Neill Institute for National and Global Health Law. 2009. Web.
Pilzer, Paul Z. The New Health Insurance Solution: How to Get Cheaper, Better Coverage Without a Traditional Employer Plan. NY, John Wiley and Sons. 2006.
Sage, Bobbie. “Interstate insurance.” Personal Insurance. 2009. Web.