DeParle: “It’s a new day when it comes to oversight. There’s a tension, it’s an inherent tension, but I’m happy about where it’s going.”

Yesterday, California became the first state in the nation to pass the bills setting up insurance exchanges through the legislature. The exchanges would not come online until 2014, but the state now has four years to codify the rules.

Unfortunately, those exchanges are four years off, and in the meantime, California will see rates continue to skyrocket in the individual market.

During the health care debate, one of the biggest question marks that I had was whether the insurance regulations, which would be handled by the states and not a federal regulator, would be enforceable. Countless examples of insurance companies getting off scot-free, or of state insurance commissioners lacking the will or the resources to stop them, raised my concern. Now, Robert Pear and Kevin Sack at the New York Times add to that concern by discovering that some state insurance commissioners don’t even have the authority to uphold the regulations in the Affordable Care Act.

I seem to remember an analogy during the health care debate from Tom Harkin, about the Affordable Care Act being a starter home. It wasn’t perfect, he said, but over time, Congress would add to that home, and fix it where it’s broken, and eventually create a fine stately mansion where the starter home once stood.

At least in the near term, there’s no way that’s happening.

In a completely obvious maneuver, the Senate parliamentarian has kicked out the Health Insurance Rate Authority from the reconciliation set of fixes. The national rate reviewer would have had the ability to cancel premium increases across the country, in association with state regulators. But it has no primary budgetary impact, so out it goes.