President Trump said Wednesday that he could take executive action next week to allow insurers to sell health plans across state lines and make it easier for individual consumers to buy coverage as a group, a policy approach long championed by conservatives.
Trump's comments, which came on the same day that insurers in about three dozen states had to finalize their federal contracts to offer 2018 coverage under the Affordable Care Act, did little to allay their concerns or those of state officials.
"I'll probably be signing a very major executive order where people can go out, cross state lines, do lots of things and buy their own health care," Trump told reporters on the South Lawn. "It's being finished now. It's going to cover a lot of territory and a lot of people, millions of people."
Trump has repeatedly emphasized his interest in allowing insurers to offer plans across state lines, which conservatives argue would lower premiums by fostering greater competition. The proposal under consideration at the White House was put forward by Sen. Rand Paul (R-Ky.), who balked this week at supporting the party's most recent effort to undo the ACA, and administration officials are confident that addressing this issue would make Paul more open to backing future health-care legislation.
Paul said on MSNBC's "Morning Joe" Wednesday that he had spoken multiple times to Labor Secretary Alexander Acosta about the prospect of reinterpreting a provision of ERISA, the federal Employment Retirement Income Security Act, to allow individuals to buy health plans in another state. Corporations can already do so.
"Conservatives are still fighting for free-market reforms to the health care system," Paul said in a statement. "I am excited to be working with President Trump on this initiative."
Under Section 1333 of the ACA, states already have the ability to enter compacts to allow insurance to be sold across state lines — as at least eight have done. But insurers have been reluctant to participate, in part because creating plans subject to different regulations in different states can be costly and time-consuming. Most consumers have little incentive to buy coverage that includes out-of-state doctors and hospitals.
"The provider network is probably the biggest thing we think about," said Kristine Grow, a spokeswoman for the industry group America's Health Insurance Plans. "Products are designed for the state based on networks within that state."
Mike Consedine, president of the National Association of Insurance Commissioners, said in a statement that officials would have to review the executive order but noted the association's long-standing opposition "to any attempt to reduce or preempt state authority or weaken consumer protections."
Lanhee Chen, a research fellow at Stanford University's Hoover Institution, said it makes sense that Trump is seeking to "move the ball forward on conservative priorities" now that health-care legislation has stalled.
Meanwhile, insurers and state officials are pressing the administration to commit to providing cost-sharing subsidies for all of 2018. These payments to insurers help low-income ACA consumers afford other coverage expenses, such as co-pays and deductibles.
California, Florida and other states had directed insurers this spring to file two sets of premium rates: one that assumed the cost-sharing subsidies would continue and one assuming they wouldn't. But now, just weeks away from the Nov. 1 start of open enrollment, insurers still don't have certainty.
Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) had been working toward an agreement on funding the subsidies at least through 2018. They resumed those talks Wednesday, with Murray saying they would try to strike a deal as soon as possible.
Trump told reporters that over the next two months, as he awaits another congressional vote on repealing the 2010 health-care overhaul, "I'm also going to meet with Democrats, and I'm going to see if I can get a health-care plan that's even better."
But Murray said that any effort to foster bipartisanship should start with the administration extending those cost-sharing payments. "That would be a concrete step to ensure people's health care doesn't become unaffordable," she said.
Final 2018 rates will be set regardless. On Tuesday, Florida announced that rates for its mid-level "silver" plans will be 31 percent higher next year, partly because of the lack of certainty around cost-sharing subsidies.
A spokeswoman for Covered California said the state will announce its 2018 marketplace rates next Monday. Insurance Commissioner Dave Jones warned that they'll be higher unless Trump or Congress provide assurance soon that the payments will continue.
"Unless the Republican-controlled Congress and the president do their jobs immediately by funding the cost-sharing reductions in the ACA for 2018, then health insurance premiums for the most popular product in our state exchange will be an average of 13 percent higher," Jones said in a statement.