Even though a very high percentage of enrollees left those plans, an even larger number entered these plans. The marketplace may have taught these plans how best to market their plans to people, but the market certainly was not establishing service quality or consumer protections desired by plan enrollees. Federal legislation is needed because the protections that do exist today constitute a veritable patchwork quilt that is undecipherable by the public. Enormous differences exist today in the protections that are afforded to people based on the accidental happenstance of a consumer's state of residence and the payer and form of their health plan. Enormous differences also exist in the protections provided for people in Medicare, those in fully insured plans, those in self-insured plans, and people in the Medicaid program.
Enormous differences exist in the protections provided by one state versus other states.
Finally, enormous differences exist among people within the same state, especially between those who get their coverage from an employer who is fully insured or those who self-insure. Consumers need greater certainty about the basic protections that are guaranteed to them. National standards should establish a basic foundation that nobody can fall through. The President's Commission engaged the services of the Lewin Group to analyze two of the most discussed recommendations, the provisions relating to an external appeal and information disclosure. An examination of some of the other proposed protections would show that some of the proposals would add no costs to the health care system or could result in cost savings.