President Obama's proposal to try to let more people keep their canceled health insurance policies sounded so simple when he announced it Thursday.
"Insurers can extend current plans that would otherwise be canceled into 2014. And Americans whose plans have been canceled can choose to re-enroll in the same kind of plan," he said in unveiling the proposal at the White House.
In other words, if your insurance company says so, you can keep your existing health policy for another year. But you might have missed what the president said right before that: "State insurance commissioners still have the power to decide what plans can and can't be sold in their states."
Indeed. But there's a problem with that.
"In some of these states it may actually be against state law to implement the president's proposal," says Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms.
Corlette says several states — some put the number at around a dozen — have basically written the Affordable Care Act's requirements into their own state laws. But it also means that starting Jan. 1, 2014, even if the federal government says canceled plans can continue for another year, state regulators might find their hands tied by their own state laws.
Indeed, Corlette says eight states have already moved to prevent or restrict insurers from renewing plans now that extend into 2014. That's something the federal law does not prevent.
But in most of the states, whether or not to allow insurers to reverse the cancellations will, indeed, be up to state regulators. And they seem to be divided on the issue, along lines that are not necessarily partisan. California's insurance commissioner, for example — a Democrat — has announced that he will support allowing insurers to go forward if they want to.
But Mike Kreidler, the state of Washington's commissioner — also a Democrat, and a former member of Congress — has said an emphatic no. He says his state's health exchange is working smoothly and he sees no reason to make changes now.
"It would have been very disruptive to try to figure out a way to implement the president's suggestion," Kreidler says. "And, quite frankly, I'm not even sure it would have been feasible under the best of circumstances."
Kreidler says allowing canceled plans to continue would also be unfair to the state's insurance companies. The firms have already set their rates based on the assumption that most people will be buying plans that do meet the new requirements.
"When you change the rules halfway through the game, all of a sudden everything they'd been operating under with certain assumptions goes away," Kreidler says. "And that would have been very difficult for the market."
That may be true, says Kansas Insurance Commissioner Sandy Praeger, but she's worried about people in her state being unable to get onto the balky federal website and get any insurance at all. That's why she's planning to take up the president's offer, even if the older plans don't cover a full array of benefits or pre-existing conditions, as the new rules require.
"Our first responsibility is to protect the consumers," Praeger says, "and at least in my mind that means finding a way to let them stay on those policies if they want."
About the only thing that's clear right now: More than ever, if you're shopping for an individual or small-business plan, the kind of health insurance you can get depends in large part on where in the country you live.