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CMS wants to know how best to sell health insurance across state lines

The agency seeks information on removal of regulatory, operational and financial barriers, but will insurers step into the interstate market?

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services has issued a request for information to get recommendations on how to eliminate regulatory, operational and financial barriers to allow insurers to sell plans across state lines.

CMS wants feedback on how states can take advantage of the Affordable Care Act, which provides for the establishment of a regulatory framework that allows two or more states to enter into a "Health Care Choice Compact" which would facilitate a plan for interstate sales.


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CMS said it wants to understand the financial impact of selling health insurance across state lines, with the goal of reducing premiums and increasing competition.

Average market premiums through the federal exchanges more than doubled from 2013 to 2017, CMS said. Some counties had only one issuer in 2018.

That changed this year when premiums dropped and insurer participation increased for 2019 plans. CMS said it believes expanding the sale of health insurance coverage across state lines could provide more options and plans.


The RFI will be open for public comment for 60 days.

CMS is using the ACA as a guide because the Affordable Care Act included a provision allowing insurers to sell policies across borders if states entered into "compacts," according to  The ACA also enacted country-wide standards for benefits and coverage. Before the ACA, states varied widely in what they required of insurers on the individual market.

Several states have passed laws allowing for cross-state sales, but insurers have not jumped into the interstate market. One reason cited in a National Conference of State Legislatures report, is that it may represent a lot of effort for little return.


The RFI builds on President Trump's October 12, 2017 Executive Order to promote choice and competition in healthcare. It specifically instructs the facilitation of the purchase of health insurance 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," CMS Administrator Seema Verma said. "We are looking for information and ideas from the public on how to create a more dynamic health insurance market with more insurers participating and competing to meet the needs of the American people just like we see in markets for so many other products and services that enhance our daily lives."

Twitter: @SusanJMorse
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