Donald Trump’s plan to ensure that people with pre-existing conditions get healthcare coverage raised serious doubts among healthcare experts, with one saying Monday it “makes no sense.”
Presidential debate moderator Anderson Cooper asked Trump during the presidential debate Sunday night how repealing Obamacare would ensure that people with pre-existing conditions get coverage, a provision of the law the GOP nominee has supported. The provision requires insurers to cover people with chronic conditions such as diabetes.
Trump responded by pointing to his plan to increase competition by letting insurers sell plans across state lines.
“You’re going to have plans that are so good because we are going to have so much competition in the insurance industry,” Trump responded.
He said earlier in the debate that Obamacare needs to be repealed “because it will never work. It is very bad health insurance.”
“We have to get rid of the lines around the state where we stop insurance companies from coming in and competing,” Trump added.
Trump’s opponent, Democratic nominee Hillary Clinton, has called for keeping Obamacare but installing some fixes aimed at reducing out-of-pocket costs.
Trump’s plan would allow an insurer in one state’s insurance market to offer plans in another state. Currently some states allow that practice, but only if the plan meets that state’s requirements.
However, some experts doubted Trump’s plan would ensure people with pre-existing conditions would get guaranteed coverage.
“It makes no sense,” said Gary Claxton, vice president of the nonpartisan Kaiser Family Foundation.
Claxton said that if insurers aren’t required to enroll people with pre-existing conditions, who cost more to treat, then “nobody is going to take them.”
Another expert said Trump’s claim doesn’t appear to meld with the goal of eliminating borders.
“It seems completely inconsistent to me,” said John Holahan, institute fellow at the left-leaning Urban Institute, unless Trump is “thinking that if we didn’t have a lot of insurance regulations people with pre-existing conditions might be able to get coverage at a lower cost [through] an out-of-state policy.”
Several analyses of Trump’s healthcare plan have said that letting insurers sell plans across state lines could result in people getting less coverage.
Claxton said there are two ways to implement the policy. The first would be that states could enter into compacts with each other in which they create an agreed-upon set of rules.
The other way is to allow an insurer to offer a plan it has in one state to another state and would pre-empt the receiving state’s insurance regulations.
Each state currently has its own rules for what must be included in an insurance plan.
Holahan said that states such as Maryland and New York have stiff insurance regulations, but Trump’s plan would mean that a person could buy a plan in Wyoming, a state that has cheap insurance rates.
“If you are in Maryland or New York, then that Wyoming insurer could sell in your state, then you could buy a cheaper policy that might have less benefits,” he said.
The plan could create some states that “have virtually no rules, which would mean you could offer insurance with much more limited benefits,” Claxton told the Washington Examiner. “That would lead some people to buy policies that don’t cover very much.”
Trump’s plan says that insurers would be able to offer plans only if they meet the insurance requirements of the receiving state.
There is another problem with selling plans across state lines: Insurers would have to find a way to enter that market and forge contracts with doctors and hospitals.
“It is not easy to do that, particularly when you don’t have any market share yet,” Holahan said. “Co-ops ran into problems and ended up paying a lot to rent somebody’s network and it cost them.”
Holahan was referring to the 23 taxpayer-funded consumer oriented and operated plans. Of those 23, only five co-ops are still functioning as intended as many collapsed due to financial problems.
Even if insurers were allowed to sell across state lines, barriers such as “building a network and attracting enough customers to create a large enough risk pool make it unappealing to insurers to pursue this option,” according to an analysis from the Center for Health & Economy.
It is not clear what effect such a policy would have on premiums, the think tank found.
“The cost of health care varies across different regions of the country in ways that may not be related to the insurance market,” it said. “As an ‘exported’ plan is sold in various areas, it is possible that the rates of that plan may increase to deal with the cost of insuring people in more expensive markets.”
