Debra Miller

Today, NBC news published a report that President Trump has said he is about to sign an executive order to allow Americans to purchase health insurance policies across state lines. The ACA already has a provision for selling insurance across state lines so long as the plans meet certain minimum standards of coverage and five states have such laws on the books already. However, no insurer currently sells such policies.

Remember that after the Affordable Care Act passed, numerous commentators predicted that increased insurance coverage, achieved through purchase of individual plans through the ACA marketplace or expanded Medicaid coverage, would precipitate a primary care shortage? Experts feared that those with new coverage would not actually have access to care and those previously insured might experience decreased access to primary care. Studies have shown that primary care availability hasn’t suffered as expected.

The bill proposed this week by Senators Graham and Cassidy would repeal many provisions of the  Affordable Care Act and redesign the Medicaid program. Through 2026 the federal government would  provide each state a block grant in lieu of funding for Medicaid expansion and subsidies for health insurance purchased through the ACA marketplaces. Federal funding for Medicaid, absent the expansion, would be converted to a per capita cap basis, reducing federal expenditures over time. After 2026, the block grant would disappear. The bill would also eliminate consumer insurance protections of the ACA including prohibitions against annual and lifetime limits and underwriting practices related to pre-existing conditions.  

On Aug. 30, Ohio Gov. John Kasich and a bipartisan group of 7 other governors released a letter to congressional leaders that outlines reforms Congress should consider to strengthen states’ health insurance markets.