Get Congress to allow health insurance across state lines

“The insurance companies are getting rich off health care and health insurance and everything having to do with health. We’re going to end that. We’re going to take out the artificial boundaries, the artificial lines. We’re going to get a plan where people compete, free enterprise.”

Trump-o-Meter: Get Congress to allow health insurance across state lines


Selling across state lines not part of GOP proposal

Both in the Republican primary debates and on his campaign website, Donald Trump talked about making sure people can buy health insurance from companies in other states.

"We have our lines around each state," Trump said at the Feb. 6, 2016, primary debate in New Hampshire. "The insurance companies are getting rich on health care and health services and everything having to do with health. We are going to end that. We're going to take out the artificial boundaries, the artificial lines."

By design, the American Health Care Act drafted by House Republicans is silent on selling across state lines. In the course of a half-hour slide presentation, House Speaker Paul Ryan said the policy is very much on the agenda, but not now.

"That's a reform that we've long believed in, that we think is really important to get regulatory competition to give people even more choices," Ryan said.

The hitch is, Ryan explained, the surest and quickest path to removing several key elements of the Affordable Care Act, i.e. Obamacare, is through a congressional maneuver called budget reconciliation. Under those rules, a simple majority in the Senate assures passage, rather than the 60 votes needed to stop a filibuster.

That's a big advantage for Senate Republicans, who hold 52 seats.

But the budget reconciliation rules limit what can be included to direct changes in taxes or spending. So removing taxes on the well-to-do and reducing Medicaid payments to states are fine. Selling across state lines might not pass muster.

"We would love for that to be in the reconciliation bill, but the rules in the Senate don't allow that to happen," Ryan said.

Parliamentary expert Molly Reynolds at the Brookings Institution in Washington told us interpreting the Senate rules is very tricky, but it's likely that the measure at hand would run afoul of two of them.

"The first is a restriction on provisions that don't actually change federal outlays or revenues," Reynolds said.

The other basically says the link to spending or taxes has to be pretty direct.

In any event, the provision for buying and selling insurance across state lines is not in the American Health Care Act, something Trump acknowledges.

"Don't worry, getting rid of state lines, which will promote competition, will be in phase 2 & 3 of healthcare rollout," Trump tweeted March 7.

Trump's promise is on hold for now. We rate this promise Stalled.

See Figure 1 on


CNN, Paul Ryan's entire health care bill PowerPoint, March 9, 2017

House Republican Leadership, Introducing the American Health Care Act, accessed March 14, 2017

New York Times, The Problem With G.O.P. Plans to Sell Health Insurance Across State Lines, Aug. 31, 2015

The Hill, Ryan brings out slideshow to sell GOP healthcare bill, March 9, 2017

Email interview, Molly Reynolds, fellow in Governance Studies, Brookings Institution, March 14, 2017