The State Flexibility ObamaCare Doesn't Allow

The Department of Health and Human Services (HHS) likes to tout the "flexibility" it claims it's giving state governments to implement ObamaCare. An agency press release last month, for example, announced the release of rules governing ObamaCare's "essential health benefits" under the headline "HHS to give states more flexibility to implement health reform." Rules governing the establishment of the law's state-run health insurance exchanges promised to give states flexibility 38 separate times.

But when it comes to ObamaCare's new health insurer spending regulations, HHS doesn't seem nearly as interested in letting states have the flexibility to implement the law as they think might be best. This week, HHS denied the requests of two more states, Kansas and Oklahoma, to adjust the law's medical loss ratio (MLR) requirements, which require insurers to spend a at least 80 or 85 percent of their total premium revenue on activities that meet the government's definition of "clinical services." Last month, HHS denied a similar request from Florida to modify the law's MLR requirements.

That's not to say that all states have gotten the same treatment. Last March, Maine's MLR request was granted on the basis of an HHS determination that the rule "has a reasonable likelihood of destabilizing the Maine individual health insurance market" which indicates that, at minimum, HHS is aware that the rule has the potential to upend an insurance market. But never mind the downsides; federal bureaucrats, not state governments, will determine if the potential problems are bad enough to matter. The differing decisions just underlines the point: HHS seems more committed preserving its own flexibility to selectively apply ObamaCare's rules and regulations when and where it wants than to granting states real freedom to determine how they would like to implement the law. 

Related: The Congressional Budget Office says the MLR requirements aren't quite a government takeover of health insurance, but they're pretty close. 

Comments

[Jeffersonian]

The thill of seeing the first of many infallible Five Year Plans is almost too much to bear.

[Almanian]

But our Politburo is so much more capable than THEIR Politburo ever was - ours will get it right!

Top. Men.

[Almanian]

Peter Suderman:

1) You are getting very good with the alt text

2) "I am Gumby, damn it! I AM entertainment!"

3) This does NOT make up for the Placenta Bear posting on Twitter, you heartless bastard. I'll have nightmares for weeks....

[Peter Suderman]

1) thanks!
2) ...
3) I promise never to link to a Placenta Teddy Bear toy on Twitter again. Or at least not until it's really necessary.

[Peter Suderman]

1) thanks!
2) ...
3) I promise never to link to a Placenta Teddy Bear toy on Twitter again. Or at least not until it's really necessary.

[Ted S.]

You don't, however, promise not to double post

[Raston Bot]

OT, from Agitator:
http://www.sltrib.com/sltrib/n.....csp?page=1

Utah drug bust results in 1 dead cop, 4 injured cops, and 1 injured Army vet who was self-medicating. Dude was stationed at Bragg when active. Special forces?

[Almanian]

Holy shit! PWNED!

[wylie]

Investigate who's house you're barging into? NEVA!

[BakedPenguin]

Ogden officer killed in firefight 'doing exactly what he wanted to do'

So he was suicidal?

[Apatheist]

I shed no tears for someone who exactly wants to enforce the WOD.

[capitol l]

If they want to call it a fucking war, get all dressed up like real soldiers, and shoot at American citizens then fuck 'em.

As far as I'm concerned Matthew Stewart is an American POW.

[Brendan]

Bingo, in war there are casualties on both sides and it's largely accepted as a consequence of being at war, so deaths and injuries shouldn't come as such a surprise.

If they don't like taking casualties on their side, they should cease engaging in war.

[Brendan]

My response was "darn".

This is the same department shown here:
http://www.youtube.com/watch?v=WV6Bq8xeQrU

I have zero sympathy for them. As I stated in my youtube comments, this is simply karmic retribution and/or another example of "what goes around comes around".

The disparity in how yesterday's incident was treated compared to the blair incident is amazing. This is a department that had no problem risking other people's safety and no problem killing a guy without warning, yet it's a terrible horrible tragedy perpetrated by a coward when they encounter someone as reckless and violent as them.

It's basically a group of playground bullies crying and commiserating about one of their own getting after a lone student gives him a bloody nose.

[Brendan]

It's basically a group of playground bullies crying and commiserating about one of their own getting after a lone student gives him a bloody nose.

[Brendan]

I really suck at html, just remove the word "getting".

[Ted S.]

There's no HTML involved in just typing in a text box. :-p

I presume you meant "getting it" or "getting his".

[Brendan]

I rephrased what I said and missed one word. I wanted to repost the line in question with the errant word struck through. The del html tag doesn't seem to work.

I meant to say:
"It's basically a group of playground bullies crying and commiserating about one of their own after a lone student gives him a bloody nose."

It wasn't enough to point out that the analogous bully simply gets a bloody nose. The bully, while in his group, was struck by one guy whereas he and his buddies operate in a group against individuals.

[Juice]

They drew first blood, not me.

[Surtton Johansen]

Wow, that looks like its gonna be good. Wow.

http://www.Privacy-Pros.tk

[Rich]

"Flexibility" -- you know, like "transparency".

[Barack Obama]

Dammit...I HAVE TO GO IT ALONE!

[Res Publica Americana]

The sad thing is that there are so many hooks and dependencies between the state and federal governments, not a single state is prepared to just simply, purely, unconditionally tell the federales to fuck off. What happens if the Supreme Court upholds ObamaCare? We're so utterly fucked.

[jhoger]

More of our premium dollar going to care than insurance company overhead = "fucked?" Please give me your address so I can send you a complimentary dictionary.

[Sevo]

"Last March, Maine's MLR request was granted on the basis of an HHS determination that the rule "has a reasonable likelihood of destabilizing the Maine individual health insurance market""

Translation:
"On review of your plea, Maximum Leader has decided *you* do not have to follow the law!
Next!"

[jhoger]

No, your translation is uninformed and dead wrong. The law explicitly allows HHS to make a determination and grant this flexibility to avoid destabilizing the market. It was Congress's EXPRESS intent, period.