Healthcare professionals across the country are calling foul on Republican presidential nominee Donald Trump’s proposal to improve the Affordable Care Act by allowing insurance companies to sell policies across state lines.
Though Trump has repeated this plan often throughout the campaign, it surfaced again to greater prominence Sunday night during his debate with Democratic nominee Hillary Clinton. Asked by an undecided voter how the candidates would address rising premiums and improve coverage, Trump called for the repeal of the ACA and again invoked his proposal to remove state barriers for insurers.
“We have to get rid of the lines around the state, artificial lines where we stop insurance companies from coming in and competing,” Trump said. “That gives insurance companies essentially monopolies. We want competition.”
Establishing such a “national market” for health insurance remains a popular idea among Republicans, but for many in the healthcare industry, it’s an idea without substance.
“This proposal is really more of a throw-the-stick-to-the-wolves option,” Linda Blumberg, a senior fellow at the Urban Institute’s health policy center, told Modern Healthcare.
“That’s not the way you create a well-functioning healthcare system.”
She stressed that under the ACA, companies are already allowed to sell across state lines if there is an agreement between the two states – yet no major insurers have pushed for it.
If a national market were put in place, Blumberg said it would likely result in many companies choosing to compete only in states with little to no regulation, and then offering low-cost, low-coverage plans to mostly healthy people.
“Sales across state lines would reduce premiums for those who are healthy at a given time while increasing premiums and reducing access to coverage for those with current or past health problems,” the Urban Institute concluded earlier this year.
Those points were backed by Julie Rovner of Kaiser Health, who called the effect a “race to the bottom” in which carriers would move to states with loose regulations on benefits and sales practices.
“That could put consumers on the hook if something happened,” Rovner said.
Detractors of the plan also say it would be difficult for an insurer to set rates, negotiate agreements with provider networks and create a viable offer without access to consumer data.
Rovner concluded by pointing out that the three states already allowing out-of-state selling – Georgia, Maine and Wyoming – have not seen “a single insurance company offer[ing] to sell a product approved in one state to people in another state”
Though the insurance industry has largely remained silent on the issue, insurance regulators oppose the idea due to the questions and complications it would raise over regulatory authority. The National Association of Insurance Commissioners released a brief saying allowing insurers to sell across state lines would make companies less accountable and prevent regulators from exercising consumer protection.
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