It’s an idea that gets talked about as a way to stabilize the Affordable Care Act’s individual marketplaces: Allow payers to sell insurance across state lines.
President Donald Trump favors the idea, but many think it's a Republican talking point that's probably not feasible. It would require a vote from Congress to repeal the McCarran-Ferguson Act, put in place in 1945, which made insurance regulation a state responsibility.
One point absent from the discussion during the debate on whether to allow interstate insurance sales is the potential impact on doctors, according to Medical Economics. There are pros and cons.
Allowing new insurers into a state could offer a greater choice of payers for doctors to contract with, according to the article. But critics say that doctors could have less protection in dealing with out-of-state regulators.
For example, out-of-state plans could omit the requirement for prompt payment to providers that some states have, Trish Riley, executive director of the National Academy for State Health Policy, told the publication. It could also make life more complicated, as doctors who want to appeal a payment from an insurance company might have to do so in a different state.
Doctors might also find more of their patients with narrower coverage, higher premiums and higher co-pays, if critics are right about the impact of allowing payers to sell insurance in other states.
Medical groups that represent doctors are split on the idea. The American Medical Association at its annual meeting in June reiterated its support of the sale of health insurance products across state lines. It clarified that position with a new policy to ensure patient and provider protections consistent with and enforceable under the laws of the state where a patient lives.
“Healthcare markets need increased competition, as too many of our patients face too few choices when seeking coverage. But in expanding these opportunities, we must ensure that the insurance products being sold comply with state laws intended to protect consumers,” AMA board member Russell W. H. Kridel, M.D., said at the time.
But the American College of Physicians opposes any change if it allows insurers to circumvent state regulations, according to Medical Economics.
No matter, the idea is a long way from reality. “You just don’t see it on the agenda,” Sabrina Corlette, a professor at Georgetown University’s Center on Health Insurance Reforms, told the publication. “From both ends of the political spectrum, you see people saying this is kind of a dumb idea.”