The Trump administration says offering health insurance across state lines will enhance competition and lower premiums, but states may raise objections if their regulatory authority is challenged.
The Centers for Medicare & Medicaid Services wants suggestions on how to "eliminate regulatory, operational and financial barriers" that hinder the sale of health insurance plans across state lines.
"Eliminating the barriers to selling health insurance coverage across state lines could help provide access to a more competitive and affordable health insurance market," she said.
In an October 2017 executive order, President Donald Trump mandated that CMS "facilitate the purchase of health insurance across state lines," which the administration said would "provide relief from rising premiums by increasing consumer choice and competition."
CMS said it wants feedback on how states can take advantage of Section 1333 of the Patient Protection and Affordable Care Act, which provides for a regulatory framework that allows two or more states to enter into a Health Care Choice Compact to facilitate the sale of health insurance coverage across state lines.
Specifically, federal policymakers are looking for input on how to expand access to health insurance coverage across state lines, effectively operationalize the sale of health insurance coverage across state lines, and understand the financial impacts of selling health insurance coverage across state lines, CMS said.
Trump's 2017 executive order also directs the Secretary of Labor "to consider expanding access to Association Health Plans, which could potentially allow American employers to form groups across State lines." That would allow health insurance providers to bypass state coverage requirements.
Health insurance oversight is left largely to the purview of states, which has created a regulatory patchwork that varies widely from state to state.
State and federal lawmakers, mostly Republican, have for the past decade pushed to sell health insurance across state lines, but the issue has proved to be nettlesome. The National Association of State Legislatures reports that at least 23 state legislatures have considered the idea over the past 10 years.
The National Association of Insurance Commissioners hasn't taken a firm stand on the idea, because it represents independent state insurance commissioners, many of whom may have varying levels of support for the idea.
In the past, however, state insurance commissioners have been reluctant to support any federal initiatives on the issue that weaken states' regulatory oversight.
A NAIC spokesman on Wednesday declined to comment, but said the association would respond to the RFI.
The RFI will be open for public comment for 60 days.
“Eliminating the barriers to selling health insurance coverage across state lines could help provide access to a more competitive and affordable health insurance market.”
CMS Administrator Seema Verma
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
CMS has issued a request for information about selling health insurance across state lines.
The RFI follows up on a 2017 Trump administration executive order that CMS "facilitate the purchase of health insurance across state lines."
State insurance regulators have traditionally looked askance at any federal initiatives that weaken their oversight.