Talk­ing point or real so­lu­tion? Ex­perts as­sess Trump’s fa­vorite health re­form idea

Modern Healthcare - - NEWS - By Shan­non Much­more

At the sec­ond gen­eral elec­tion de­bate, Don­ald Trump once again touted al­low­ing health in­sur­ers to sell plans across state lines as a way to make cov­er­age af­ford­able af­ter killing the Af­ford­able Care Act. But the pol­icy could un­der­mine the in­di­vid­ual mar­ket and roll back pro­tec­tions that con­sumers have come to rely on.

Trump hasn’t ex­plained how such plans would be reg­u­lated. Nor did he an­swer de­bate mod­er­a­tor An­der­son Cooper’s di­rect ques­tion of whether the plan would main­tain an in­sur­ance man­date for in­di­vid­u­als.

“As long as the plan pur­chased com­plies with state re­quire­ments, any ven­dor ought to be able to of­fer in­sur­ance in any state,” his cam­paign says in a 3½-page ad­den­dum to health pol­icy bul­let points on his web­site. “By al­low­ing full com­pe­ti­tion in this mar­ket, in­sur­ance costs will go down and con­sumer sat­is­fac­tion will go up.”

But most health pol­icy ex­perts say the op­po­site is likely to hap­pen.

Linda Blum­berg, a se­nior fel­low at the Ur­ban In­sti­tute’s health pol­icy cen­ter, said she thinks Trump has stuck with the pro­posal as the cen­ter­piece of his health­care talk­ing points be­cause it sounds sim­ple and ef­fec­tive to peo­ple who aren’t tuned in to health pol­icy and be­cause it’s pop­u­lar with other Repub­li­cans.

“He’s not a nu­anced guy,” she said. “I have no ex­pec­ta­tion that he has a lot of un­der­stand­ing of how pri­vate health in­sur­ance mar­kets work. I’m not sure he cares.”

Joe Antos, a health pol­icy ex­pert at the right-lean­ing Amer­i­can En­ter­prise In­sti­tute, said it’s more likely just one of the ideas Trump re­mem­bered on the de­bate stages than a pol­icy he truly be­lieves in. “I think it’s stuck in his head,” Antos said. “This is an ex­am­ple of Don­ald Trump not be­ing nearly as pre­pared as Hil­lary Clin­ton is on any topic.”

The idea of sell­ing health in­sur­ance across state lines has been men­tioned in some con­ser­va­tive cir­cles for many years. It was first in­tro­duced at the fed­eral pol­icy level by two Repub­li­can mem­bers of the House pro­mot­ing the Health Care Choice Act of 2005, ac­cord­ing to the Robert Wood John­son Foun­da­tion. The bill did not pass.

Al­though the pol­icy is pre­sented as a way to pro­vide more op­tions and com­pe­ti­tion, Blum­berg said, it would un­der­mine state in­sur­ance reg­u­la­tions and make ac­cess dif­fi­cult for peo­ple with health prob­lems.

“This pro­posal is re­ally more of a throw-the-sick-to-the-wolves op­tion,” she said. “That’s not the way you cre­ate a well-func­tion­ing health­care sys­tem.”

If the ACA were re­pealed and in­sur­ance com­pa­nies al­lowed to sell across state lines, health plans would most likely es­tab­lish them­selves in states with the least reg­u­la­tion and then fo­cus on sell­ing low-cost plans with min­i­mal cov­er­age to healthy peo­ple.

That would leave an un­bal­anced risk pool and cause peo­ple with health prob­lems to go with­out cov­er­age or pay ex­or­bi­tant prices.

And in­sur­ers don’t ap­pear to be all that in­ter­ested in sell­ing in­ter­state plans. Un­der the ACA, they are al­ready al­lowed to sell across state lines if there is an agree­ment be­tween the states. The plans must still meet cov­er­age re­quire­ments of the fed­eral health­care law, which also spells out li­cens­ing re­quire­ments and how dis­putes would be ad­dressed.

No state has taken ad­van­tage of this op­tion and no ma­jor in­surer has asked for it.

Blum­berg said it would be dif­fi­cult for an in­sur­ance com­pany to jump into an­other area and es­tab­lish provider net­works, make ne­go­ti­a­tions and set proper prices with­out ex­ist­ing con­sumer data.

In­sur­ance reg­u­la­tors also gen­er­ally op­pose the con­cept be­cause it would raise ques­tions about reg­u­la­tory author­ity. State reg­u­la­tors don’t have the re­sources to watch other states. The Na­tional As­so­ci­a­tion of In­sur­ance Com­mis­sion­ers said in a pol­icy brief that al­low­ing in­sur­ance to be sold across state lines would make in­sur­ers less ac­count­able and pre­vent reg­u­la­tors from as­sist­ing con­sumers in their states.

While con­ser­va­tives gen­er­ally be­lieve re­duc­ing reg­u­la­tion will un­leash mar­ket forces and drive down prices, state reg­u­la­tion of health plans isn’t what’s mak­ing pre­mi­ums rise, Antos said. “What re­ally drives the cost of health­care is the cost of the ser­vices and the bar­gain­ing power of the in­sur­ance com­pa­nies.”

“I think it’s stuck in his head. This is an ex­am­ple of Don­ald Trump not be­ing nearly as pre­pared as Hil­lary Clin­ton is on any topic.” JOE ANTOS Health pol­icy ex­pert Amer­i­can En­ter­prise In­sti­tute

AP PHOTO

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