When you talk to GOP lawmakers in the Congress about an overhaul of the Obama health law, one of the most mentioned items by Republicans is making it possible for insurance companies to sell health coverage policies across state lines, as the Trump Administration argues that will help promote competition, and bring down prices for consumers.
"There's no question about it," said White House Press Secretary Sean Spicer on Tuesday, "if one plan can sell that was in Maryland - into Virginia - where they could seek additional customers, that competition alone invariably brings down costs."
"Once you allow competition, by itself that will bring down costs, it will bring in choice," Spicer said, as he told reporters that such a plan would likely be part of a broader health policy bill in Congress, known as "phase 3" of GOP efforts on health care.
But while this is a big Republican selling point in the health care debate, a quick look at current federal law shows that selling health insurance policies across state lines is already allowed - ironically, there is a provision to do that under the Obama health law.
Just grab your handy copy of the Affordable Care Act, and there in Section 1333 is where states can agree to "health care choice compacts" that would allow health insurance companies to sell their products across states lines.
The fine print from 2010 shows us that the feds were to work with the National Association of Insurance Commissioners to develop regulations for that interstate sale of health insurance.
Credit: Jamie Dupree
Credit: Jamie Dupree
But those regulations for "interstate health care choice compacts" between states were never issued - in fact, the Obama Administration never consulted the NAIC at all.
"The NAIC was never asked to develop the standards," the group told me earlier this week.
Since those regulations have never been issued, that would seemingly give a big opening to Health and Human Services Secretary Tom Price to administratively make the push for interstate sale of health insurance - since he would now be in charge of setting the ground rules.
Credit: Jamie Dupree
Credit: Jamie Dupree
Under the provisions of the Obama health law, any state compacts to allow for the interstate sale of health insurance would have to include the ten Essential Health Benefits (EHB's) that govern the minimum coverage standards set out by the Affordable Care Act for insurance sales.
It is important to note that those EHB's are not set in stone in the Obama health law, as section 1302(b) gives the HHS Secretary the power to "define the essential health benefits," in ten different categories.
In other words, Secretary Price could first set the ground rules for the interstate sale of health insurance, and then tweak the minimum standards for what needs to be covered in such a plan, all without any action by lawmakers in the Congress.
In fact, in a Friday meeting with GOP lawmakers, Price indicated that he may be ready to issue a new rule on Essential Health Benefits - but there was no mention of a change on selling insurance across state lines.
One must point out in this discussion, that while the issue is popular with many Republicans, there are a number of people who see pitfalls in such a move.
One reason is that individual states regulate insurance sales, setting many of their own rules dealing with coverage.
So, while it might sound simple to someone outside the insurance industry, there would actually have to be some uniformity on sales of insurance across state lines - that's why the Obama health law requires states to set out agreements in advance with each other.
For example, if the state of Florida required health plans to cover preexisting conditions - but the state of Georgia did not - would Florida have to allow Georgia insurers to sell in the Sunshine State, even though they have lower coverage standards?
Again, all of that could be hammered out administratively right now - but so far, Republicans and the Trump Administration have showed no interest in what's already in federal law.
Selling insurance across states lines - it's already allowed - in the Obama health law.
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