The Republican Study Committee and Blue state experimentation

The Republican Study Committee is the policy group of the most conservative Republicans in Congress.  They have a health insurance bill out and there is a lot to say.  I only want to highlight one item though in Section 401:

‘‘(a) IN GENERAL.—Subject to section 601(d) of the American Health Care Reform Act of 2017, the covered laws of the primary State shall apply to individual health insurance coverage offered by a health insurance issuer
in the primary State and in any secondary State, but only if the coverage and issuer comply with the conditions of this section with respect to the offering of coverage in any secondary State.
‘‘(b) EXEMPTIONS FROM COVERED LAWS IN A SECONDARY STATE.—Except as provided in this section, a health insurance issuer with respect to its offer, sale, rating (including medical underwriting), renewal, and issuance of individual health insurance coverage in any secondary State is exempt from any covered laws of the secondary State (and any rules, regulations, agreements, or orders sought or issued by such State under or related to such covered laws) to the extent that such laws would— (My emphasis)

‘‘(1) make unlawful, or regulate, directly or in directly, the operation of the health insurance issuer
operating in the secondary State, except that any secondary State may require such an issuer—

That one sentence effectively forecloses any Blue state solution that relies at all on the individual market.  It blows up the Massachusetts model for if an insurer can register in New Hampshire as its primary state, it can sell across the border into Massachusetts where it offers medically underwritten policies with significant benefit carve-outs such as no maternity coverage.  The Massachusetts risk pool will become extremely sick or extremely likely to be pregnant.  That will significantly raise premiums and death spiral the non-subsidized and lightly subsidized portions of the three legged stool market.

Blue states can experiment under this law only in ways in which they will allow themselves to be subject to regulatory capture and race to the bottom of standards.


33 replies
  1. 1
    quakerinabasement says:

    Well sure. But states DO get to decide how best to screw Medicaid patients.

  2. 2
    Davis X. Machina says:

    I thought being able to sell across state lines was going to fix everything, not blow everything up.

  3. 3
    dmsilev says:

    So much for federalism and states’ rights.

    Not that anyone really believed that the GOP actually believes in that; it was simply convenient at the time for them to pretend.

  4. 4
    dmsilev says:

    @Davis X. Machina: It ‘fixes’ things in the veterinary sense.

  5. 5
    Davis X. Machina says:

    @dmsilev: Next you’re going to tell me that tort reform isn’t going to wipe out my copays….

  6. 6
    hovercraft says:

    @Davis X. Machina:
    The point is to maximize profits, not to cover the most people or provide the best coverage, so in that sense they are ‘fixing’ the system, they are allowing the insurance companies to return to making as much money as possible while providing as few benefits as possible.

  7. 7
    hovercraft says:

    States rights are all well and good when the democrats are in charge, but when they are in charge it’s their way or no way. They are all for local control, just look at NC, where McRory lost his governorship all because his legislature and him could not abide Charlotte granting their citizens equal rights and protections under the law.

  8. 8
    Villago Delenda Est says:

    These bastards of the “Republican Study Committee” all need to be put up against the wall.

  9. 9
    Minivet says:

    Hm. Couldn’t a state get around that by instituting its own individual mandate that includes quality requirements for the insurance mandated? It would suck that the burden of noncompliance falls on the individual more than the insurer, but good enough labeling requirements could mitigate. (It looks like the draft legislative text does require prominent disclosure when a policy is being sold across state lines.)

  10. 10
    Mnemosyne says:


    When you break something so no one else can ever use it again, that’s the same as fixing it. That’s what their abusive daddies told them, and they still believe it.

  11. 11
    rikyrah says:

    thank you, Mayhew.
    finding out the truth.
    this is who they are

  12. 12
    ruemara says:

    @efgoldman: I think he intends for them to provide ballast for the wall.

  13. 13
    Ohio Mom says:

    Maybe this is denial but I truly believe that one day all this nonsense will be in the history books. People will wonder how we ever got so off track, how we ever voted in such awful individuals. But I have no hope I’ll live long enough to see this.

  14. 14
    Juice Box says:

    @Davis X. Machina: Of course selling across state lines fixes everything. It allows economies of scale which will lower the cost of health insurance for everyone. For instance, if you have a set of states with a population greater than Canada, then health insurance will be cheaper there than in Canada. That’s why health insurance is cheaper in California (pop. 38M) than Canada (pop. 34M), right?

  15. 15
    Yutsano says:

    Why do I see a bunch of state insurance commissioners going “AWW HELL NAW!!!” to this?

  16. 16
    Davis X. Machina says:

    @Juice Box: It doesn’t have to work in practice — it only has to work in theory.

    Grace comes to us through faith, not works.

  17. 17
    Davis X. Machina says:

    @Yutsano: Federal pre-emption. It’s what’s for breakfast.

    The fact that the Roberts court found some cockamamie equal sovereignty of the states doctrine in NFIB v. Sebelius won’t even be a speed bump if the GOP in Congress needs it to go away.

  18. 18
    Raoul says:

    Republicans and health care policy can basically always be called “race to the bottom.”

    I just wonder how many will sicken and die before we are able to throw them out. Looking at places like Brazil and Argentina, unfortunately it might be decades. Dammit.

  19. 19
  20. 20
    Mnemosyne says:

    @Davis X. Machina:

    Grace comes to us through faith, not works.

    I know the Catholic Church had its problems at the time but, really, did Martin Luther actually create a net improvement in the world?

    (Yes, not satisfied with re-starting the Great Primary Wars, I’m now moving on to re-fighting the Reformation just for giggles.)

  21. 21
    Another Scott says:

    It looks like approximately the same bill died in committee in June 2015. What killed it then? Just the promise of Obama’s veto? No path to get it through the Senate without 60 votes? Something else?

    Presumably the Team D people on the various committees (“Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, House Administration, Rules, Appropriations, Veterans’ Affairs, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.”) know what’s what and have plans to fight this.

    We can hope, anyway. ;-)

    It’s good to keep an eye on this stuff, but we shouldn’t assume (and I don’t think you’re doing so) that just because they have a small majority now and have the Presidency that they will get their way in everything.

    We need to fight them, and not assume we’re going to lose. We must make them beat us if they want this crap, not roll over and let them take it.

    Even the Teabaggers want to be popular and want to be re-elected. They’re not invincible.

    Thanks, Richard.


  22. 22
    Omnes Omnibus says:

    @Mnemosyne: Given that Luther and the other early Protestants were primarily objecting to the patent corruption of the Renaissance Catholic Church, the argument can be made. The Reformation also lead to the invention of the Jesuits. The leading lights of the Reformation were, in addition, some of the top scholars of their time.

  23. 23
    randy khan says:


    That would be a good start. I’m sure we could add to the list if we put our minds to it.

  24. 24
    Mnemosyne says:

    @Omnes Omnibus:

    I’m not saying that no good at all came from it. Just that it may not have been an overall net positive given that people now feel empowered to make up their own reality based on their personal understanding of the Bible.

  25. 25
    Omnes Omnibus says:

    @Mnemosyne: Well, of course, having someone like Benedict tell you what morality is works so well.

  26. 26
    Davis X. Machina says:

    @Omnes Omnibus: The consensus omnium fidelium, and not the Pope, is where the buck stops. Garry WIlls is good on the subject.

    Before 1870 there was no papal doctrine of infallibility and its introduction split the Church. There are a lot of Catholics who still consider it a dangerous novelty.

  27. 27
    Another Scott says:

    Shouldn’t someone on Team D come up with some section in there that is secret language for Death Panels FEMA Camps and Forced Abortions Jade Helm in there somewhere [sic]? If not, what are those Elbonian fake news kids up to these days, since the elections are over? They should get back to work! InfoWars and Betsy McCaughey need material!!



  28. 28

    Trump has made me a supporter of states rights.

    Trumpcare. Much worse than Obamacare.

  29. 29
    Omnes Omnibus says:

    @Davis X. Machina: Cool. I also don’t feel like going into details about how the non-hierarchical Protestant churches determine doctrine. One Congregational church could be stunningly liberal while the next one over would not be. Nevertheless, those church ended up as the Mainline Protestants who are now over all liberal.

  30. 30

    @Another Scott: Completely agree that this bill as written is going nowhere. However it is a good indicator of what is on the Republican wish list (much like single payer bills that are introduced and go nowhere are good indicators of what is on some portions of the left’s wish list)

    And given that the Republican Party controls 218-51-1-4 (where ties goes to 218-51-4) and they operate under Hastert Rules, being aware of the implications of the wish list is valuable.

  31. 31
    Sunny Raines says:

    The fetid putridness of the republican soul knows no bounds; what’s with republicans always going out of their way to screw people – especially the most vulnerable; can only be sadism – no other explanation

  32. 32
    Kansi says:

    Because states’ rights!

  33. 33
    JGabriel says:

    @Davis X. Machina:

    I thought being able to sell across state lines was going to fix everything, not blow everything up.

    Blowing everything up IS the Republican definition of fixing everything; e.g. Iraq.

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