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CPBJ Extra Blog

The national story is not the local story

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“The United States regulatory system is unique in the sense that we have 56 jurisdictions that regulate the business of insurance. Most countries have one regulator. So part of my goal is to showcase how our state-based system works, why it works well.”

That quote is from Iowa Insurance Commissioner Nick Gerhart, organizer of the first Global Insurance Symposium, which has scheduled keynote speakers from Japan, India and Germany.

I'm not at all sure that what Gerhart said is substantively true. Not that I suspect him of prevarication — but on health care at least, the federal government is now so involved that, from where I sit, it hardly seems fair to refer to, say, the Pennsylvania Insurance Department as the regulator of health insurance in the state. If you follow the news at all, you know that, because of Obamacare, there have been a lot of regulations and changes in the past couple of years, and you also know that those have largely been coming from Washington, not Harrisburg.

Despite all the work that PID does, the feds are in charge now. I wish it weren't that way, because PID is way better at answering my questions than the whole HHS/CMS/IRS/DOL/White House conglomerate is. Plus, covering a national story of the type that frequently relies on unnamed but highly placed sources is a big stretch for local publications. But it passed nationally and it's being implemented nationally and all my grousing won't change that.

That's one side of the story.

The other side is that despite all the federal control on health insurance, thanks to Obamacare, there are huge differences in what health insurance looks like state by state. And those differences are largely due to whether the state elected to expand Medicaid, whether the state elected to run its own marketplace, and what the state health insurance market looked like before Obamacare came along. On this angle, the state decisions loom pretty large (although, admittedly, not all of said decisions were under the aegis of state regulators).

Together, they make a complicated, one-size-doesn't-fit-all picture. And as I look at it, I wonder whether the disparity between states will persist and, if it does, whether it is pronounced enough that affected people will start moving to more generous states.

And, because I'm a properly cynical journalist, I wonder whether the states they left would be sad to see them go.

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