New GOP talking point: House plan outlaws private health insurance

As I've mentioned there's an infinite number of idiotic things right-wingers believe about healthcare. Most of those are either either stupidity or lies. But now that the actual bill is available and they are starting to read it, another factor is coming into play: Illiteracy.

Simply put, HR3200 does not outlaw private health insurance, it simply moves regulation of private health insurance from McCarran-Ferguson to ERISA. What is confusing the wingnuts (not that they need help getting confused) is that the actual bill is over 1,000 pages long, it is written in legalese rather than English, and it is set in the middle of a large array of other legislation that it must work around without destroying. This necessarily means that it does some nifty tricks to side-step some of the implications. For example: For employer-provided health insurance meeting requirements for deduction as health care coverage under federal law, federal regulation already applies via ERISA This is 95% of all outstanding health insurance plans right now. But individual plans (as defined under the terms of Section 2791 of the Public Health Service Act), which are 5% of health insurance plans, are regulated by the states under the provisions of the McCarran-Ferguson Act of 1945, which places private health insurance under state control.

So the question is how to enforce the mandates upon insurers -- the must-issue and the flat-rate-pool mandates -- without overturning McCarran-Ferguson. Neither Congress nor the majority of states want the Federal government to be in the business of regulating insurance in general. Simply amending McCarran-Ferguson to exclude health insurance as a state-regulated class doesn't work either, because it's not *all* health insurance that Congress wants to regulate, just *primary* health insurance. Supplemental policies are of supreme disinterest to Congress and they're quiet happy to let the states continue regulating those. Besides, insurers could raise some legal actions if Congress tried to regulate already-issued insurance that was issued under McCarran-Ferguson.

So the solution that the wonk assigned the task of making this happen arrived at was to create a new ERISA-eligible group for all future individual insurance to be offered through -- the Health Insurance Exchange. This starts on page 72 of the bill. Since it is an ERISA-eligible group, it can be regulated through ERISA without touching McCarran-Ferguson in general. But then comes the task of how to make all individual insurance be offered via the Exchange. And the solution the wonk devised was to outlaw the issue of new individual policies under McCarran-Ferguson, which is done on page 16, which when you get to page 19 would force all new individual policies to be issued via the ERISA-regulated Exchange rather than via the state-regulated McCarran-Ferguson private market (but which does not touch existing small-group and large-group insurance as defined on page 14). In short, it's a work-around for McCarran-Ferguson which avoids the necessity to have to actually *change* McCarran-Ferguson -- existing private insurance policies can still be regulated by the states, it's just that new individual insurance that meets primary insurance requirements must go thru the Exchange where it can be regulated under federal ERISA rules instead. And wingnut heads explode upon reaching page 16, and they erupt shouting "ObamaCare outlaws private insurance!" without ever getting to page 19 much less page 72.

This points to a major problem wingnuts have with a 1000+ page bill -- you have to read the whole damned thing to know exactly how page 16 relates to page 19 and page 72, you have to know the legal background of health insurance beforehand to understand how the pieces relate to the other major pieces of federal regulation like ERISA and McCarran-Ferguson, you have to have basic literacy in the legalese involved in this massive piece of wonkery, and wingnuts lack the patience, background, or the reading comprehension to do this. The bill does not outlaw private insurance, of course. It just shifts issuance of individual policies to the Exchange so it can be regulated under ERISA rather than McCarran-Ferguson. But to someone who suffers from legal illiteracy and a case of the paranoids, taking page 16 out of context means you arrive at the erroneous conclusion "ObamaCare outlaws private insurance!", which was boldly published in a national forum without the slightest attempt to validate the conclusion with, well, somebody who knows even the tiniest bit about health insurance regulation and how the new bill interacts with the current regulatory framework.

So it goes. In wingnut land, ignorance is strength. And on that basis, they must be mighty goddamned strong, doncha think?!

-- Badtux the Healthcare Wonk Penguin