With health care reform back on the table—and possibly up for a House vote next week—the nation’s attention is turning back to just what President Donald Trump’s long-term plan for fixing health care is. The president has promised a three-phase rollout in which the GOP effort to repeal the Affordable Care Act is only the first step. One of the next steps, which he promises will reduce costs and give more people insurance, is an opening up of the state-by-state insurance system.
The president and his staff have returned to the topic multiple times. During his February address to Congress, the President ticked off his approach to health care reform, ending with a plan to “give Americans the freedom to purchase health insurance across state lines.” Later, within hours of Republicans outlining their legislation for replacing Obamacare—which didn’t include such a provision—Trump tweeted, “Don’t worry, getting rid of state lines, which will promote competition, will be in phase 2 & 3 of health care rollout.” White House press secretary Sean Spicer repeated the promise after the Congressional Budget Office delivered a tough score on the GOP’s original replacement plan.
The president clearly is committed to the state-line policy. If he wants a small win on health care to distract from the challenges of getting a large-scale repeal through Congress, this idea might meet that goal. But there’s one big problem: No one in the health care universe, on either the policy side or the business side, actually thinks selling plans across state lines will make a difference.
How do I know this? I chair the Zetema Project, whose mission is to foster open dialogue and debate on U.S. health care issues. Panelists include Republicans and Democrats, policymakers from the Obama White House and both Bush administrations, current Capitol Hill staffers, and senior executives representing hospitals, insurers, pharma, organized medicine, employers, patients and other key stakeholders. The group comes together in candid, off-the-record meetings not to work out solutions but to argue about issues deeply to make sure everyone understands their differences. You would think that this group couldn’t agree on much of anything, and you’d be right—almost.