to decide the issue. Preemption of state law can be express or implied so even if the bill doesn't say it prevents states from establishing a single payer plan, it still might. Here's why:

Preemption can be either express or implied. When Congress chooses to expressly preempt state law, the only question for courts becomes determining whether the challenged state law is one that the federal law is intended to preempt. Implied preemption presents more difficult issues. The Court has to look beyond the express language of federal statutes to determine whether Congress has "occupied the field" in which the state is attempting to regulate, or whether a state law directly conflicts with federal law, or whether enforcement of the state law might frustrate federal purposes.

Federal "occupation of the field" occurs, according to the Court in Pennsylvania v Nelson (1956), when there is "no room" left for state regulation. Courts are to look to the pervasiveness of the federal scheme of regulation, the federal interest at stake, and the danger of frustration of federal goals in making the determination as to whether a challenged state law can stand.

If the law is seen as "occupying the field" of healthcare law, then state law will be trumped by it even if the bill itself doesn't say that.

Which doesn't mean it isn't worth looking (and if I get a chance I will) just that it may not end the inquiry. I wish I knew more about healthcare law. As it is now, I wouldn't be able to analyze the bill for implied preemption.

For example, NYS requires that certain things be covered by all plans. (NYS had a mental health requirement before the federal law.) It would be good to know if the HELP (as in "Help, I'm drowning!"?) plan would affect the ability of the states to regulate those aspects.

I will take a look when I have a chance.

Also, when talking about these congressional plans, people (I'm looking at you, Krugman) still seem to be focused on the problem of getting more people covered by insurance and not on the "have insurance but can't afford to use it" or "have insurance but they won't cover what I need done" aspects, which to me are just as important and urgent. Well, there's that Times article (and there have been others) - but when evaluating these plans, this aspect has not been mentioned, or I've missed it.

Obama should have had a Town Hall "Debbie" with problems like Lawrence Yurdin from the Times article:

Too many other people already have coverage so meager that a medical crisis means financial calamity.

One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.

He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.

At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.

He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.

In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there.

...or just my son, who is paying a higher premium for his employer-provided health insurance because he has a chronic problem that he wanted extra coverage for - but the (in-network) provider is still sending him a bill for most of the cost of the treatment. (Oh, and the thing he paid extra to have covered? Turns out they will only pay for about two-thirds of what he needs.) He's thinking of dropping the insurance altogether and using a medical account instead, because he's paying so much for the insurance and they are just screwing around with him.

Oh, guess who his insurance parasite is? Aetna!

under ERISA. If so, then federal law supersedes state law, and single payer is out.

Since it came up last night (and since I'm busy researching them):

‘‘(j) SINGLE RISK POOL.—
‘‘(1) INDIVIDUAL MARKET.—A health insurance
12 issuer shall consider all enrollees in an individual
13 plan, including individuals who do not purchase such
14 a plan through the Gateway, to be a member of a
15 single risk pool.
16 ‘‘(2) GROUP HEALTH INSURANCE POLICIES.—A
17 health insurance issuer shall consider all enrollees in
18 a group health plan, other than a self-insured group
19 health plan, including individuals who do not pur-
20 chase such a plan through the Gateway, to be a
21 member of a single risk pool.

(Sorry, the line numbers are in the pdf. It's one of the reasons reading it is inducing a medical condition.)

Apparently this would replace, for example, NY State's community rating. Hipparchia mentioned last night that there might be differential premiums based on age groups - if so, they're not doing it by manipulating the risk pools. But it would be better if there were only one big risk pool and everyone were in it... I mean...

for existing State requirements and so on, but they're not things I can easily interpret.