Just 1 Reason Why The PPACA/Obamacare Is Controversial

First page of Constitution of the United States
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One thing that every American can agree on is that the Patient’s Protection and Affordable Care Act is controversial.  Whether a person refers to it as the Affordable Care Act, PPACA or Obamacare is really immaterial. 

This post quotes one of the sections included in the law and offers two very different ways people can view it.  It is up to you, the reader, to decide which is more important.  Either point of view is acceptable, depending on your personal values.  Just keep in mind that it is often wiser to have a full understanding of something you are dogmatic on than to just parrot what you hear someone else say.

With 906 pages of new law and additional regulations being made daily by the Secretary of Health and Human Services, it is impossible for the new law to “please all the people all the time.”

This post is just an example of why good people can have different opinions on this most controversial law in the last 50 years.




(1) IN GENERAL.—Not later than July 1, 2013, the Secretary shall, in consultation with the National Association of Insurance Commissioners, issue regulations for the creation of health care choice compacts under which 2 or more States may enter into an agreement under which—

(A) 1 or more qualified health plans could be offered in the individual markets in all such States but, except as provided in subparagraph (B), only be subject to the laws and regulations of the State in which the plan was written or issued;

(B) the issuer of any qualified health plan to which the compact applies—

(i) would continue to be subject to market conduct, unfair trade practices, network adequacy, and consumer protection standards (including standards relating to rating), including addressing disputes as to the performance of the contract, of the State in which the purchaser resides;

(ii) would be required to be licensed in each State in which it offers the plan under the compact or to submit to the jurisdiction of each such State with regard to the standards described in clause (i) (including allowing access to records as if the insurer were licensed in the State); and

(iii) must clearly notify consumers that the policy may not be subject to all the laws and regulations of the State in which the purchaser resides.

(2) STATE AUTHORITY.—A State may not enter into an agreement under this subsection unless the State enacts a law after the date of the enactment of this title that specifically authorizes the State to enter into such agreements.

(3) APPROVAL OF COMPACTS.—The Secretary may approve interstate health care choice compacts under paragraph (1) only if the Secretary determines that such health care choice compact—

(A) will provide coverage that is at least as comprehensive as the coverage defined in section 1302(b) and offered through Exchanges established under this title;

(B) will provide coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title would provide;

(C) will provide coverage to at least a comparable number of its residents as the provisions of this title would provide;

(D) will not increase the Federal deficit; and

(E) will not weaken enforcement of laws and regulations described in paragraph (1)(B)(i) in any State that is included in such compact.

(4) EFFECTIVE DATE.—A health care choice compact described in paragraph (1) shall not take effect before January 1, 2016.


This is a section of the PPACA that could be interpreted in a couple of ways.  Those who view the PPACA as a reform of the health insurance industry will like this section.  By allowing people to purchase health insurance that is sold in a different state, there is the possibility of an initial premium reduction. Just keep in mind that this option will not be available until 2016, two years after the “Individual Mandate” for all Americans to purchase health insurance or pay an IRS fine begins in 2014.


Those who view the PPACA as a first step in a federal power grab see things differently.  The 10th Amendment of the U.S. Constitution grants the right to regulate commerce to states only within their states.  This is a major reason why insurance companies only conduct business in states in which they are “admitted”. 

This section of the PPACA grants insurance companies the right to sell the same policies in multiple states across state line.  When that happens the federal and not the state governments have the right to implement regulations.  In theory, a federal representative from a different state, say California, would have the ability to recommend laws for people in a compact between Oklahoma, Texas and Louisiana.


While the PPACA language appears to guarantee that the individual states would retain control of the insurance industry the U.S. Constitution differs.  It clearly states that the federal congress is to regulate inter-state commerce.  It would be up to the courts to decide whether the language in the PPACA or the U.S. Constitution takes precedence.  My opinion is that the “safe guards” for state self-regulation would not hold up when challenged by the U.S. Constitution and the federal government could take control of the health insurance industry anytime they felt like it.

This section of the PPACA is just one of the areas that good people differ on.  What is scary is that “State’s Rights” was a major reason why the Confederacy was formed in the 19th century and the American Civil War was fought.  There were good people on both sides of that conflict as well.  I just watched a documentary on what happened in the years after the American Civil War.  Although there were no armies in the fields, there was still violence in the states as the Radical Republicans continued to force their will on the population even when they did not want it.


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