For the last 10 months, states have been legally allowed to let insurers sell plans outside their borders.
Despite the idea’s enduring popularity, no states have signaled interest in the policy, insurance experts and regulators say. And the federal government never even finished writing the rules for how it would work.
“Insurers aren’t interested at this point,” Linda Blumberg, a senior fellow on health policy at the Urban Institute, said in an interview. “It’s kind of a lot of effort for no necessary return.”
ObamaCare’s little-known provision that allows insurers to sell plans across state lines was tucked inside the 1,000-page law at the time of its passage, though it didn’t go into effect until January 2016.
Under the law, two or more states can band together into what’s called a “healthcare choice compact.” That means people can buy health coverage from another state that wouldn’t be subjected to the rules of their home state, as long as those states agree.
States would have to explicitly pass legislation to empower insurers to enter into these agreements.
Thirteen states have tried to pass these laws since ObamaCare was signed in 2010, in part because of a push by the powerful conservative group
American Legislative Exchange Council.
Only three states have approved those laws — Kentucky, Georgia and Maine — although none have actually made deals with other states to sell their plans, according to the National Conference of State Legislatures.
Conservatives say the provision that’s already in the law is far from what Republicans have in mind when they’re touting the idea on the campaign trail.
“It’s like a fake-out, and it’s not even a very convincing fake-out,” said Tom Miller, a health policy expert at the conservative American Enterprise Institute.
Insurance companies in these special agreements under ObamaCare would still have to follow the law’s minimum standards, which requires all health plans to cover certain types of providers and services in each network. The biggest change is that companies could skirt rules that are stricter than ObamaCare’s.
“All that’s saying is, you get to do something different as long as you do the same thing you’re doing before,” Miller added.
In the GOP’s ideal world, companies would be selling insurance across state lines without the mandatory coverage requirements of ObamaCare.
Candidates like Trump have vowed to entirely repeal the healthcare law. States would again set their own regulations, leaving GOP-controlled statehouses to set low regulatory bars with hopes of driving down the costs of health plans.
Insurers not interested in selling ObamaCare across state lines