ACA Title 1, Sec. 1333. Provisions relating to the offering of plans in more than one state:”Good” – Mostly – Establishes multi-state health plan offerings. This section of the ACA provides for health plan providers to offer the same plans to the individual and/or small group markets in one or more states. Their state of domicile controls in terms of insurance regulation. The relationship is called a “Health Care Choice Compact” and are slated to be operational no earlier than January 1, 2016. Restrictions regarding “Essential Health Benefits Coverage” and cost sharing limits also apply. Another category of multi-state health plans is also authorized by this section and they are called “Nationwide Qualified Health Plan” and here the provision seems to be written for organizations like the Blues. Again the plans must meet minimums. These plans have to be rolled out in a timely manner and plans are linked to modified community rating which is not good if plans that require wellness are not included. Philosophically the entire law establishes a variety of similar health plans in terms of benefit coverage and cost sharing limits that compete with each other in the marketplace. Variety or diversity in plan design is discouraged and competition between plans mainly on price seems to be the major antidote to high health plan costs. Actually its relatively easy to see how the various legislative proposals from federal legislators were combined with little concern for duplication. Congress seems to have decided that more is better and the more competing plans the better. But a major change that seems to be overlooked is the absence of a provision that would provide an incentive for people to engage in wellness and health lifestyle choices. This concern seems to be relegated to another universe or time dimension.

Please let others know about this blog and have them “follow” @Wellness Czar on Twitter for the section topics. This information is also available in summary PDF form by making a request to [email protected].