A popular idea tossed around in the search for effective healthcare/insurance reform is the notion of selling insurance across state lines. Along with malpractice reform, this often tops the list of solutions, especially from Republicans, even as the main culprit, unnecessary third-party payment, is not even mentioned. At a recent debate for an open seat in the US House in the district where I live all five GOP candidates spoke in favor of this concept. Yet is it a good idea or possibly the source of more trouble, and are there other means to attack the existing problem?
On the surface it would seem like a fantastic idea and with good reason. The argument goes that more competition would bring down prices. After all, the opportunity to purchase a health plan from a company not doing business in a particular state would now be available. More importantly, because insurance is separately regulated state by state, it would now be possible to circumvent excessive mandates and regulations that much more dramatically affect price than the number of company choices available. Both the number of coverage mandates and the nature of them varies greatly from one state to another. In a few states simply requirements for community rating and guaranteed issue have made the individual market so expensive as to all but destroy it. In this sense, so long as there are at least three or four company choices anyway, the ability to purchase insurance regulated and approved in another state would change the nature of the competition from one of price to that of determining the least amount of expensive regulation and mandates the buyer felt was needed for their protection. So far, so good. What is not to like?
The problem and basis for the argument against what would seem like such a good idea on its surface is the Commerce Clause of the US Constitution, or rather more correctly, the modern perverted interpretation of it. What began as a provision to facilitate exchange among the states has over time become an excuse for the Federal Government to impose all manner of meddling and micro-management to anything bought or sold across state lines. The fact that insurance is not bought and sold across state lines should serve as a defense against such federal meddling and against the imposition of Obamacare itself. In this regard, providing for such interstate commerce would open the door to the legitimate intrusion of the federal government and surrender of the defense that exists without it.
The origin of state control of insurance was the McCarran-Furgeson Act of 1945 which exempted insurance from federal anti-trust laws and left regulation to the states. Right up to today this has kept federal regulators mostly out of the picture, with the exception being health insurance. Even there federal intrusions have been few and limited until the passage of Obamacare. The fact that they went unchallenged by the states was absolutely a mistake by the states, but the extent and nature of the intrusions was of limited scope and never sparked challenges that should have occurred. Now with the passage of Obamacare the federal government has become the bull in the china shop, seeing no limit to its authority, even though a reasonable defense against it still remains so long as we do not move to purchase across state lines.
Two possible alternative solutions come to mind. The first makes the most sense and leaves little doubt as to its effectiveness. Those states that have ruined their health insurance market by excessive and abusive mandates and regulation need to fix their problem internally. Rolling back that which has caused the problem will eliminate it and do for its citizens exactly what providing the opportunity for circumvention would do. The second solution is more problematic and questionable. That would be to possibly keep the federal government out by the formation of compacts among states that want to provide for the purchase of each other’s health insurance plans. Since compacts must be approved by congress and the internal solution would work as well, this approach would not be suggested.
The bottom line here is that what seems like a great idea to solve a known problem may simply cause even more trouble, give away a reasonable defense, and end up being in the category of “be careful what you wish for”.