The ACA's authors aimed to bolster competition and improve access to coverage, in part, through two new health plans that would be available across state lines. By 2017, those plans were supposed to be available in all 50 states.
Reality check: Instead, there is one plan, in one state. Republicans are targeting this part of the ACA for repeal, and no one is rushing to its defense. So, what went wrong?
“They never added that much value," Georgetown University health policy professor Sabrina Corlette says of the ACA's multistate plans.
- The initial idea was to create two new plans, which would be available in every state, to help boost competition in states that lacked it. The multistate plans were administered by the same office that takes care of federal employees' health benefits.
- But the multistate plans were never a very attractive prospect for insurers. They struggled to get off the ground, never really caught on, and now are basically extinct.
- To establish a multistate plan, insurers had to go through the full regulatory process in each state, plus an additional process with the federal government — and on top of that, had to do the hard work of setting up provider networks in each state.
- “There wasn't anything the government was able to offer these companies that made it worth their while to go through the effort," Corlette says.
What's next? Sen. Ron Johnson and Rep. Mark Meadows introduced a bill yesterday to repeal this part of the ACA, saying the plans are still costing the government money even though they barely exist. It's pretty hard to pass any bill right now, but no one's rushing to defend the remnants of the multistate plan.
“I've always sort of felt like it was well-intentioned but not reflective of the right reality of what's limiting competition," Corlette says