Though Congress has once again failed to unwind the Affordable Care Act, President Donald Trump is not giving up on the effort to reshape healthcare policy.
In remarks to reporters on Wednesday, Trump said he is preparing to issue an executive order that would allow people to cross state lines in order to “buy their own healthcare.” Trump didn’t offer many specifics about the proposed policy but did indicate he was planning to sign such an order next week.
“It’s going to cover a lot of territory and a lot of people—millions of people,” he said.
Trump also indicated that Republicans would revisit their effort to repeal the ACA early next year, adding that “in the meantime, I will negotiate with Democrats to see if we can make a bipartisan bill.”
Meanwhile, in an interview with MSNBC earlier on Wednesday, Republican Sen. Rand Paul of Kentucky filled in some of the details about what Trump’s executive order might entail.
The idea, he said, would be to modify the Employee Retirement Income Security Act by expanding the definition of who can form “associations.” Corporations that operate in multiple states are already allowed to purchase insurance across state lines under ERISA, and Trump could authorize individuals to do the same.
Making that policy change, Paul argued, “will solve a lot of the problems we have in the individual market.”
The National Association of Insurance Commissioners, however, is not a fan of the idea—one that has been circulating in right-leaning policy circles for some time.
Allowing interstate sales would “make insurance less available, make insurers less accountable and prevent regulators from assisting consumers in their states,” the group said in a previously published document (PDF) titled "Interstate Health Insurance Sales: Myth vs. Reality."
For one, interstate sales would spark a “race to the bottom” in which insurers would aim to offer policies in states where regulators allow them to aggressively select for risk. Such a policy would also let out-of-state insurers lure away healthy enrollees, making existing risk pools progressively sicker. To adjust, insurers would try to design policies that discourage sicker enrollees, meaning policies would cover fewer benefits.
In fact, six states have already enacted legislation that allows the interstate sale of private insurance, and researchers from the Georgetown University Health Policy Institute have studied the results. In a report published in 2012, they note that “none of the across-state-lines laws resulted in a single insurer entering a new market or the sale of a single new insurance product.”