Insurers, providers question CMS push for crossborder plans

INDUSTRY GROUPS claim that the bottom line, not federal regulations, are why insurers don’t sell plans across state lines.

The CMS last week closed out the comment period on a request for information seeking input on how it could eliminate barriers on insurers’ ability to sell cross-border plans, reviving an idea that was a pillar of President Donald Trump’s 2016 campaign.

Industry groups contended that retooling the regulatory framework may not meet the intended goal of increasing competition between and access to different insurance offerings.

Georgia, Maine, Oklahoma and Wyoming already have laws allowing such sales, but they’ve had little success.

“These states have each taken a different approach, none of which has, to date, resulted in insurers offering comprehensive health insurance in a state in which it is not licensed,” the National Association of Insurance Commissioners said in a comment letter.

The main insurance lobby, America’s Health Insurance Plans, also noted that states can already allow the sale of plans to other states via Section 1333 of the Affordable Care Act, which allows one or more states to create a healthcare compact to sell plans.

“The main challenges states face in operationalizing cross-border individual market insurance sales would be the same in any framework. Additional federal action that is outside the option to create compacts under section 1333 would only compound those challenges,” AHIP commented.

Providers and patient advocates questioned if selling across state lines would result in lower premiums. Trinity Health, a Catholic system that operates across 22 states, noted that insurers breaking into a new market would have little bargaining power with local providers.

Providers and some state regulators were also worried about the impact on coverage of pre-existing conditions if insurers can sell cross-border plans.

“Some insurers will migrate to the states with the least stringent coverage requirements. Coupled with a marketing strategy to aggressively target the healthiest individuals, this will skew the market adversely against less healthy individuals,” Pennsylvania Insurance Commissioner Jessica Altman said. ●