Is that not what I do when comparing plans on healthcare.gov?

That’s exactly what it is except they have base “minimum essential coverage” laws that these ministries don’t abide by.

“HCSMs are not regulated by the ACA. The coverage you get will vary from one HCSM to another, but they are not required to cover pre-existing conditions, cap out-of-pocket costs, or cover essential health benefits. And they can still have annual and lifetime benefit caps.”

Since they’re not regulated entities, there’s no enforcement mechanism if you get sick and they decide not to pay out or delay your reimbursement.

I mean kind of. There’s a ton of restrictions on who can have what plan where though, it’s not a very “free” free market.

Sort of. ACA set ground rules for one segment of the market and did a good job doing so. There is a real competitive process in most states.

Taking about free markets in the context of US health insurance in general is a waste of time.

You cannot purchase plans across state lines. You cannot purchase the same plan you would get if you worked at a large company.

The law is basically written by the insurers, and favors them. It allows them to segregate people based on who they work for, etc.

In an ethical system, there would be just a single, non-segregated pool of people called a 'market', and anyone would be able to purchase any plan they want from that market, regardless of which state they lived in and regardless of who they did or did not work for.

Federal employees have such a system, and prior to obamacare, there was actually bipartisan agreement forming around enabling everyone to participate in that system. It's probably why obamacare was rushed through quickly by the insurance companies.

The state line thing makes a degree of sense in the context of the (extremely broken) network system. Your insurer has a network of providers with whom they have negotiated rates. If you live far away from your plan’s intended market, you won’t be near the network, and everyone loses except the medical providers who get to overcharge you and your insurer as a result.

It should be quite evident that everything about this system is broken, but this is part of how broken systems get entrenched.

I should remind everyone it is a republic and if you think state insurance commissions will let go of their fiefdoms I have some land in Florida I'll make you a great deal on. Kathleen Sebelius comes to mind!!

Trust me, it's worth it. Most people have no idea the kind of unethical shit that HIPAA and then the ACA regulated out of existence—stuff that would make you say "How in the name of all that is holy was that legal until 1996???"

One of the necessary casualties of that is restrictions on who is able to offer what and when. It's a good trade.

There has to be some kind of oversight. Otherwise, you get thousands of people victimized by fraud who the rest of us have to bail out.

I can buy car insurance or pretty much any kind of insurance on the market, and there is suitable oversight. This does not exist for medical insurance.

What I mean by that is if I work for a large company, I can get access to health insurance that I cannot buy on the market myself. If that company changes insurers to a crappy one, my only choice is to change employers to one that provides access to a better insurer. If I self employ, I cannot get access to those plans.

Insurers should be forced to sell in a single market all the plans they offer. Insurer like to talk about "economy of scale" with large employers, but that is an artificial limit. Why should insurance pools be limited to who works at a company?

“Insurers should be forced to sell in a single market all the plans they offer. Insurer like to talk about "economy of scale" with large employers, but that is an artificial limit. Why should insurance pools be limited to who works at a company?”

Very true. There should be one insurance pool. Either state or nationwide.

There we're state pools until Obamacare wiped those away.

Not really. A lot of people never were able to get insurance at all or lost it once they got sick.

There should be one pool where everybody can get insurance regardless of agr, employment status or preconditions. Insurers should compete for that pool.

That being said, I think uninsured drivers should go to jail/pay hefty fine/lose driving privileges, but many do not. Maybe one pool for car insurance as well?

I presume you're referring to state high risk pools, which were horrific.

Correct, and ACA EPO plans aren't an improvement, by many measures.

That's what the ACA already fixed. Insurers are forced to sell into that single market all the plans they offer in your state that are open to individuals. If you don't like your employers plan, you can just buy insurance on the ACA marketplace and decline your employers plan. Your risk pool will be other people of the same sex and age in your state.

If your complaint is that employers have access to better insurance plans on private offer, well that's true. Walmart also has self-insured property/auto coverage not available to smaller companies. But COBRA let's you stay on your employers plan if you leave for up to a year (at a pretty high cost) so that's a thing.

That... ...isn't what I was talking about?

Are there laws against offering health insurance in the open market? I'm pretty sure you could start up nonethewiser's insurance company and start taking enrollees. Or do you mean you'd have to sell them through a government portal? Or that you have to really offer a certain minimum level of care and coverage? And register with the state insurance commission? Because I'm pretty sure, except for the first one, that's a requirement for other insurances as well.