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Collecting payments is not the issue at all. There are several issues of insurance companies operating across state lines and having networks of doctors across state lines. First, you have to get a concept in your mind. From an insurance regulatory standpoint, the US is like 51+ different COUNTRIES. The USA is not one big country in terms of most laws and insurance is very complicated and different among the states. The second thing you need to think about is that when you hear of a company like Cigna, Aetna, Blue Cross, etc., these are not the actual insurance company. These are basically holding companies that own stock in many different insurance companies. They may own dozens or even hundreds of insurance companies. When I worked for Progressive Insurance I operated with 3 different companies in the state of Tennessee that only did business in TN. They were owned by the Progressive Corp, but the actual companies were not called that. Take a look at your insurance policies and you will see the actual name of the company. For example, if you get a travel policy from Allianz Assistance it will say Underwritten By Jefferson Insurance. Jefferson is owned by Allianz. Travel Guard is underwritten by companies from AIG. (My last insurance gig was in the Travel World).Every insurance company in your state must be licensed to do business in that state, must put up reserves in that state (financial collateral - money that says you can cover claims and not go insolvent), and pay taxes in that state. They are subject to regulation in that state including filing rates and rules for every program they want to write for that company in that state. This is true for EVERY line of insurance that exists (well, most of them, there are exceptions). Trust me, there hundreds of lines of insurance; most people only know life, home, auto and health. Some states even require that the company doing business in the state must be domiciled (incorporated) in that state - that is not easy for an insurance company. This means that if you want to write health insurance in a state, you have to start at least three companies (Gold, Silver, and Bronze), put up collateral, draw up paperwork, and file 3 different sets of rates and rules. Now, that is just for the market place. Plus, you may want to offer multiple types of plans within each tier. Plus you want to add employer plans too. Oh yea, can use any of the companies you are using elsewhere? Maybe, maybe not. Oh, and each of these needs licensed agents in the state to actually write policies. Yeah, that’s fun too.Here is where it gets more fun. Each of these companies has to negotiate with doctors IN THAT STATE for that individual company. Now, this is not that bad, but they still have to go through the motions and paperwork for each company - and get the providers to agree to them and the discounts - every year. Both for the employer plans and individual plans (ACA / Obamacare marketplace). Now, I’m sure that in areas that have major cities on the borders of states, like NY, NJ, and CT, or ST Louis, Kansas City, they can work it out. Also some low population states like Wyoming , Alaska, and Hawaii have to have recipirocal agreements for specialty treatment. But some states may not cooperate. I know at one time that Florida refused to agree on anything that all other states agreed on in the state conferences like the National Association of Insurance Commissioners or recommendations of the Insurance Services Office. California is another that tends to go their own way.

There are so many, but here are a few that resonated with me during President Trump’s first term in office:Tax rates for individuals and corporations were cut. Why, really, should people who work hard for their money, be forced to give it to a government that foolishly wastes it? If invested — which is what we do when we build businesses — that money could benefit so many more people and also pay a lot more in taxes.Regulations, which had shackled the creation of businesses and efficient use of resources, were removed or rewritten to be less burdensome.Trade policies were re-examined and new trade agreements with China, Western Europe, Canada, Mexico and Japan were negotiated that were fairer to the U.S. but also encouraged an increase in trade between the countries.As a result of these three things, the American economy surges to it’s best level arguably in our entire history. Unemployment dropped to historic lows, especially for minorities and women.President Trump pulled the U.S. out of a number of agreement that were poisonous to American interests, including the Paris Climate Accord, TPP, and the Iran Nuclear Agreement.The American military, which was in shambles when Trump took office, was rebuilt, and new weapons’ systems went into production, making our military again a modern force capable of handling the challenges of the 21st century.President Trump honored his campaign promise to build a wall on our southern border to reduce the drug traffic and the number of illegal aliens who have been crossing the border in the millions over the last decade.A Space Force, the first new branch of the military in over a century, was opened to help the U.S. compete with Russian and Chinese attempts to militarize space.The President began what will be a long, complicated effort to withdraw the U.S. military from our two decade adventure in the Middle East and to bring an end to it’s meaningless drain on our young people and our treasury.In response to the emergence of a deadly new virus, COVID-19, from China, President Trump closed down all flights from China and later Europe and the U.K., opened a task force to coordinate the entire federal effort to fight the disease, led many of the televised briefings for that task force, invoked the Defense Appropriations Act to get companies to manufacture medical supplies in short supply, requested that people shelter at home in order to reduce the burden on the hospitals of huge numbers of new cases, encouraged the governors of the various states to reopen them as the numbers of cases fell to acceptable levels, led Congress to write legislature to provide relief for people without an income during the lockdown, and is working to make educational funds available to parents to fund charter schools where the public schools are not going to open in September.The president has encouraged the DOJ to send Federal Agents to defend federal property in cities where violent rioters are attempting to destroy the property.Offered to send in military troops to protect the lives and property of people in cities where arsonists and looters are destroying neighborhoods.Due to the BLM and ANTIFA led efforts to defund police departments all over the country, the President has made it clear that he supports the police and honors the efforts of the men and women who serve and protect in our communities.Obviously, I’ve had to leave out some of Trump’s achievements, and I haven’t touched on his plans for next term. When you consider that previous presidents going back to Regan have failed to address so many of these issues, it is clear why his supporters consider Trump to be a pivotal president.

After he gets Brexit done, Boris Johnson and his ministers are going to take these next steps:Agree on a version the UK’s future relationship with the EU.Await the EU27 negotiation mandate which instructs the European Commission to act as agents. The UK government negotiates with the European Commission, who acts behalf of the EU member states.Begin negotiating with the European Commission. Talks are expect to start in March 2020.Appoint UK officials to work with EU officials on the withdrawal agreement’s Northern Ireland protocol joint committee. The joint committee will decide how internal UK border checks will work between Northern Ireland and rest of the UK; NI farming subsidies; fishing vessels’ landing rights and arrangements for individuals travelling from the UK mainland to NI.Reach agreement on UK-EU fishing rights. These are expected to be agreed by June 2020. Assuming agreement, UK-EU talks can move onto trade in goods. If no agreement on fishing rights, there may be a full tariff line review which covers 5,300 items of trade between the UK and EU. This is needed to avoid the risk of WTO baseline rules applying.Talks on level playing field and cross border market access - which could be linked to talks on trade in goods.Depending on sequence and success, talks can then move onto services. Critical areas include aviation, hauliers cabotage, data sharing, mutual recognition, professional qualification and financial services’ equivalence.There may also be separate talks on security, government information sharing, sanctions and foreign policy.Various talks may ultimately lead to two more deals on goods, services, security and mutual recognition.The deals will then be subject to “legal scrubbing”. This is were international lawyers check trade deal wording to ensure the deals can be operational. This process can take up to one year alone.Finalised legally certified treaties can then be subject to parliamentary scrutiny and ratification.Once ratified, there will an implement period, giving everyone time to prepare for changes resulting from the deal(s).During the implementation period, there will be new legislation, new funding, newly commissioned technology, local land planning for new customs buildings, extra staff, news business processes, training and information campaign for households.Finally, a date of enforcement for the deal(s).