While taking fire for his prior support of a single-payer health system, Donald Trump gave a hint into what he would do after repealing Obamacare.
The businessman and reality TV star said during the first GOP primary debate on Thursday that he wants to dismantle what he called “artificial lines” among the states and enable insurers to not be restricted when offering plans.
“Get rid of the artificial lines and you will have yourself great plans,” he said.
Fox News moderator Bret Baier asked Trump about his prior support 15 years ago for a single-payer health system.
Trump responded that the single-payer healthcare systems in Scotland and Canada worked for those countries 15 years ago, when he made the comments supporting single payer. But now it is a different age.
While declining to elaborate on what is different more than a decade later, the businessman outlined his vision for healthcare.
The country needs a “private system without the artificial lines around every state,” he said during the debate.
Trump said when his company negotiates for insurance in New York, New Jersey or California, he has one bidder.
“Nobody can bid. You know why? Because the insurance companies are making a fortune because they have control of the politicians, of course with the exception of the politicians on this stage,” he said, gesturing to the other nine GOP candidates on the debate stage.
The real estate mogul and current leader in national polls touched on an issue that other Republicans have advocated before, which is allowing the purchase of health insurance across state lines.
Obamacare, which Trump called an “utter disaster,” enables insurers to sell policies to other states, but with several caveats.
The law allows states to join together and form compacts that would enable insurers based in one state to sell to another state.
Only nine states had entered into compacts as of May 2014: Kansas, Alabama, South Carolina, Utah, Indiana, Georgia, Oklahoma, Texas and Missouri, according to 2014 data from the National Conference of State Legislatures.
States have tried in recent years to encourage plans to come in and increase competition, said John Holahan, a fellow at the Health Policy Center at the Urban Institute think tank.
He told the Washington Examiner that more plan options have emerged in several states. For example, Blue Cross was dominant in Alabama but Humana has come in and underbid it, he said.
There is a catch: Obamacare requires that any plan an insurer offers must meet guidelines adopted by the state, Holahan said. That creates a baseline of benefits for an insurer to meet.
So a carrier in Texas can’t just take a policy from that state and sell it in Nebraska if the policy differs from the state’s requirements.
States often set what healthcare plans should include based on the local population’s needs.
The regulation is necessary to ensure that insurers don’t circumvent state laws, said Elizabeth Carpenter, vice president at the consulting and research firm Avalere Health.
Another obstacle is whether the insurer can gain market share in another state.
“You can’t be a Wyoming carrier and come into Pennsylvania,” Holahan said. “That Wyoming plan never negotiated with a hospital in Pennsylvania or with doctors in Pennsylvania, so that is a barrier.”
