I sincerely think that, whatever is wrong with the Patient Protection and Affordable Care Act (PPACA) — and I’m certain that plenty is wrong with it — states with governors and other officials who hate PPACA still ought to do their sincere best to make the law work as well as it can work, if it’s going to be the law of the land.
If Republicans try to kill PPACA by tying it in mile after mile of red tape and get it stuck in inertia quicksand, that won’t provide any serious test of whether the ideas in PPACA work or don’t work. All of those efforts to cripple PPACA will just show what we already know: That a bill that’s implemented by officials who are, effectively, wrapped up in a bureaucratic straightjacket will probably function poorly. No kidding.
But, on the other hand: Federal regulators could show that they are genuinely interested in letting free markets (or, at least, freeish markets) work their magic by letting the more Republican-flavored ideas in PPACA work as well as they can possibly work.
One example is the Multi-State Plan Program (MSPP).
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Drafters of PPACA included the MSPP provision in PPACA to see if the “association health plan” (AHP) concept could help control costs.
Advocates of the AHP concept want, basically, for all small employers (or all individuals, or some other group of prospects) to be able to sign up for a big, multi-state, self-insured health plan that’s mostly or entirely regulated under the laws of one state.
The idea is that the enrollees in the AHP could get the same freedom from onerous state benefits mandates and other burdensome state laws and regulations that big self-insured health plans now enjoy. (The Employee Retirement Income Security Act (ERISA) has freed the big self-insured plans from state benefits mandates since 1974.)
PPACA calls for each PPACA health insurance exchange, or Web-based insurance supermarket, to offer at least two multi-state plans (MSPs).