Trump preparing order on selling health insurance across state lines

After another effort to repeal the Affordable Care Act (ACA) was halted, President Donald Trump told reporters he’ll likely sign an executive order regarding another one of his campaign promises on healthcare: allowing insurance plans to be offered across state lines.

“I’ll probably be signing a very major executive order where people can go out across state lines, do lots of things and buy their own health care, and that will be probably signed next week,” Trump told reporters on Wednesday afternoon. “It’s being finished now. It’s going to cover a lot of territory and a lot of people—millions of people.”

Trump mentioned this proposal several times as a presidential candidate, saying it would create “a truly competitive national marketplace.” It was left out of Republican bills to repeal and replace the ACA, however, with Trump saying it would be introduced in later phases of the party’s healthcare reform efforts. The idea earned support from the American Medical Association at its annual meeting in July, with the caveat that “the insurance products being sold comply with state laws intended to protect consumers.”

The proposal has ignored a largely forgotten provision of the ACA which allows states to join interstate insurance compacts. Only three—Georgia, Kentucky and Maine—have passed laws authorizing such compacts, and so far, none have reached agreements with other states.

Insurers have also shown little interest in selling across state lines. The biggest hurdle is network adequacy, with an insurer have to find enough providers and hospitals to contract with in a state where it doesn’t have existing relationships.

“We haven't yet seen the details of any proposed Executive Order and can't comment until we see the specifics,” Mike Consedine, CEO of the National Association of Insurance Commissioners (NAIC), said in a statement to HealthExec. “As a general matter, health insurers already have the ability to sell insurance in multiple states as long as they comply with state consumer protection and licensing laws, which many already do. The NAIC has long been opposed to any attempt to reduce or preempt state authority or weaken consumer protections.”

The NAIC also pointed to testimony it provided to Congress in February, when it argued consumer protections would be weakened by similar proposals by circumventing current state licensing laws for insurance companies.

“If the federal government pre-empts state licensure requirement out-of-state insurers would be able to lure healthy enrollees away from existing risk pools, which would become progressively sicker and more expensive until they ultimately fail, leaving consumers in those states with, possibly, no carriers in their states and no in-state networks of participating providers,” NAIC said in its testimony.