If I got sick really sick, and tried to get Wellmark insurance, they did not have to cover me, but now they do. Please explain how Wellmark had to pay for me in the past

You would have gone to the hospital. You would have been treated. You wouldn't have been able to pay. The insurance companies are guaranteed money for the hospital. The hospital charges insurance companies more money than they really need to in order to actually run the hospital. Insurance companies have always paid for the uninsured sick people.

The more we talk about insurance, the less you seem to understand. Most people are required to have auto insurance, yet competition is fierce as evidenced by the numerous expensive ads.

So, now that everyone has to get insurance why wouldn't their be fierce competition? How does Obamacare eliminate the competition?

Not only is anti-competitive collusion easily detected, but it's highly unlikely to occur. The more companies there are, the less likely it is. The reason is because it would be to one of the companies benefit to undercut the price and gain more customers from other would be colluders. Each company recognizes this problem so collusion rarely happens and even more rarely works.

Why don't we see Time Warner and Cox competing with each other?

You really haven't even been paying attention have you? The ACA got rid of the state sanctioned monopolistic situation. It's the one thing I liked and the thing I said it should have stopped with, remember? You already said you aren't in insurance, so you aren't going to see many of the innovations, such as the creation of new algorithms. You wouldn't know that they exist. Better algorithms are being sought all the time by insurance companies when they have to compete. These would normally drive prices down except that there are other market factors driving them up.

I asked you to show me the innovations or shut up. You came back and told me there would be innovations without pointing out any. Now that you are pointing out that the ACA got rid of monopolies it is clear that I am right and insurance companies are lying because they can get away with it. All it takes is for 1 company to start under selling the others. If that company doesn't show up, prices go up.

I said it "would" make a big difference.

Except it didn't do so pre-ACA and insurance companies themselves say it wouldn't/won't.

only Main, Georgia, and Wyoming actually implemented these across state lines laws. They did this after the passage of the ACA.

And why is that?? They have been allowed to pass such laws for more than 70 years - where was the push to do so? By states, by consumers and consumer advocates, by the insurers themselves?

The numerous market variables (such as uncertainty) as a result of the ACA must be considered.

Sure - so let's consider them - do they say their concern is the ACA: (from the same ref as before)

"Respondents universally reported the enormous difficulty that out-of-state insurers face in building a network of local providers, and insurers identified doing so as a significant barrier to market entry that far surpasses concerns about a state's regulatory environment or benefit mandates. State officials and insurers also noted that across state lines legislation ignores the primary cause of high prices—the cost of delivering care—and fails to account for often dramatic differences in the cost of care between states and regions."

"Respondents in five states reported difficulties in implementation because other states have little incentive to establish across state lines partnerships. In addition, officials and insurers in all six states noted the complexity of health insurance as a practical barrier to across state lines proposals and that establishing the rules under which an interstate health insurance compact would operate would likely demand more time and resources than states are willing to commit."

"not one state official reported any advocacy from any stakeholder, including the consumers and insurance companies the laws were designed to benefit."

"Respondents reported little insurer interest in using the laws as vehicles for entering a new market or selling new products."

"Rhode Island officials indicated that the study likely would have been completed if stakeholders had shown more interest in the study's conclusions, but noted that they have not been contacted about the issue since the law's passage."

"There has been similar disinterest from insurers: a regional health insurer based in Massachusetts indicated only minimal interest in the legislation, noting that Rhode Island's regulatory requirements are a comparatively low priority in deciding whether to enter the market."

"Among other challenges, regulators pointed to open questions such as how each state's benefit mandates and consumer protections would be treated as well as which state would enforce legal protections if a consumer had a problem with a policy."

"State officials noted that, six years after the legislation was passed, they have not received any inquiries or interest from insurers or other stakeholders regarding a compact"

"For the compact to achieve its goals, it would require leveling the wide diversity in costs of health care goods and services that exist from state to state and market to market. Because the costs of health care are based on local issues like the availability of providers and population demographics, the report concludes that a compact could not effectuate the necessary leveling of prices."

"The Washington report further concludes that the administrative costs needed to create a compact outweigh the potential benefits."

"The Wyoming insurance commissioner reached out to surrounding states shortly after the legislation was passed in 2010. However, the commissioner was unable to find a state interested or willing to create a consortium as envisioned under the law"

"Wyoming officials also reported a lack of interest from insurers with no insurer inquiries about across state lines policies since the law's passage."

"Slightly over a year later, however, regulators reported that no insurer has entered the Georgia market to offer out-of-state policies. One insurer remarked: 'Not one plan has gone through [the process of selling an out-of-state policy] and I don't think any plan will.'"

"State officials attributed the lack of insurer interest in part to a lack of consumer demand, noting: 'Insurance companies are pretty informed about what their customers want and there just hasn't been the groundswell of consumer demand that perhaps the proponents envisioned.'"

"Officials also acknowledged that the law's requirement that insurers maintain a Georgia license could be a barrier for some out-of-state insurers. In most states, the licensing process can be costly and require an extensive review of a company's solvency, business plan, governance and financials."

"Although domestic insurers maintain licensure in Georgia and, thus, could conceivably offer products that they make available to consumers in other states, state officials suggested that domestic insurers have little interest in “cannibalizing” their own, established products with cheaper alternatives from other states. As a result, domestic insurers are thought to be as unlikely as out-of-state insurers to offer out-of-state policies in Georgia."

"a regional insurer, based in Massachusetts, reported that the company is “always looking at expansion opportunities” in New England, but is not considering Maine because of difficulties in establishing a provider network in the state, which was referred to as a 'very challenging environment.'"

"The first challenge is that across state lines laws do little to address the most significant barriers to market competition and affordable coverage. The second challenge is that across state lines laws cannot be fully implemented without significant effort from state regulators and insurers to address legal and practical hurdles."

"Officials and insurers in all six states reported that their across state lines legislation was largely unsuccessful because of the localized nature of how health care is delivered, rather than the state’s regulatory requirements."

"Out-of-state insurers thus face a chicken-and-egg dilemma: they must build a sufficient membership to negotiate competitive rates with providers, but, to garner that membership, they must show customers they have an adequate network of providers and charge a premium that is comparable to their competitors."

"Respondents universally reported the enormous difficulty that out-of-state insurers face in building a network of local providers, and insurers identified doing so as a significant barrier to market entry that far surpasses concerns about a state’s regulatory environment or benefit mandates. This difficulty is compounded in states like Maine, Washington, Wyoming and Georgia, which face provider shortages in rural areas."

"A Washington state official suggested that, for western states in particular, building a provider network is such a barrier that, in all likelihood, only old-fashioned indemnity (i.e., not network-based) plans would be viable."

"State officials and insurers also noted that across state lines legislation ignores the primary cause of high prices— the cost of delivering care—and fails to account for the dramatic differences in the cost of care between states and regions and, in some cases, within a single state."

"Thus, while the cost of an individual health plan may be less expensive in a neighboring state, those rates are typically lower because of the prices charged by providers rather than the state’s regulatory environment. Thus, insurers seeking to expand from a low-cost state to a high-cost state may find that premium differentials disappear once the cost of care is taken into account."

"many state regulators are reluctant to relinquish some or all authority to enforce state standards by taking the risk of allowing another state to establish and enforce consumer protections that affect their residents. For example, officials in three of the states questioned how to implement a compact or across state lines policy that allows the secondary state to enforce the laws of the primary state and vice versa."

"Even if authority is clearly determined, some questioned whether a primary state would have the capacity to enforce its regulations and provide protection to consumers in other states."

"Although not one of the states studied here, Louisiana regulators reported to the Senate Committee on Insurance that the sale of health insurance across state lines “would provide minimal consumer protections and minimize our state’s oversight” in part because regulators’ “attempts to remedy a Louisiana resident’s insurance complaint would be hindered when the product was purchased in another state."

"officials and insurers in all six states noted the complexity of health insurance as a practical barrier to across state lines proposals."

"Although the administrative obstacles to regional sales or compacts may be surmounted if health insurers, consumers, employers or other health care stakeholders were advocating for the laws to be fully implemented, not one state official reported advocacy from any stakeholder, including insurance companies. Insurers reported little interest in using the laws as vehicles for entering a new market or selling new products."

"To a large extent, the bills moved through state legislatures thanks to the efforts of well-positioned legislators, think tanks and, in some states, small business trade groups. They advanced often in spite of opposition from consumer and patient advocacy groups. But once enacted, these laws appear to lack any organized champion."

The only mention of ACA's impact was that state officials "were too busy with implementation of the ACA to devote the time necessary" - which certainly was not the case before the ACA passed, and is not likely posing the same burden years later.

One may look at what happened to auto insurance if one is concerned about a “race to the bottom”. Mega companies such as Progressive and Geico are constanty competing to cut costs while attracting customers with appropriate coverage (lest they face embarrassing publicized lawsuits).

Here is where I think you are going to feel quite embarrassed - auto insurance is largely regulated by the same laws regarding state control that health insurance fell under pre-ACA (McCarran–Ferguson Act, etc.). Kind-of (completely) undermines your argument, eh?

The alternate is actually credit card companies which, once allowed, moved to the couple states with the fewest laws (no usary limits, etc), and use their lobbying power on state officials, etc. - all very predictable.

RE: "Ramsey said insurers are especially likely to take advantage of the law if the Supreme Court determines that the health care law is unconstitutional."

The issue of constitutionality was decided the same year the article was written - nearly 3 years ago now, yet still no interest. Also worth noting that if it have been ruled unconstitutional, we would have reverted back to the previous laws, under which, not one state even passed a law to study it, much less allow it.

This article indicates why the previous two articles show lack of enthusiasm on the part of insurers. The OPM is overly restrictive and is a profit killer.

Where does the ref say either of these things?

This also would not explain why no states allowed it pre-ACA.

The OPM has manifest the first multi-state plans in the country.

Competition not only causes companies to try to lower costs to attract more consumers

As I said - buying across state lines isn't likely to increase competition ("Competition will decrease...") - so your argument is misdirected.

just as it has in auto-insurance (which has plenty small business/local insurers in the market despite the national market place)

Again - embarassing...

if the minimum for health care didn't require my premium to cover myriad situations for which I am at 0 risk for

It doesn't. Of the 10 required benefits, the only one that is partially said of is the maternity benefit, but, even though you may not be likely to get pregnant, you are likely to pose a similar risk as others in your age group for complicity in, shall we say, acts which potentially result in the use of said benefits... ;)

You can keep your insurance if you like it, but only if Washington likes it too.

Another common misconception. See my debate with Cartman here

Thank you for explaining. I agree with you 100%. Where are you on the political spectrum?