Obamacare has not done much to slow the growth of health care costs. Government actuaries project that health spending will grow 5.8% a year over the next decade — substantially faster than growth in the economy. Could Republican proposals to sell health insurance across state lines bend the cost curve and make premiums more affordable?

The idea seems simple enough. Right now, if you are buying your own health insurance, that coverage must be sold by an insurer regulated in your state. Instead of a national market, health insurance is sold in 51 state markets (including D.C.) with differing regulations.
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During his short stint leading health policy for the Trump administration, Dr. Tom Price spearheaded a number of efforts to ease the regulatory burden on the industry, especially for his peers in the physician community.

While few expect the administration to dial back on that commitment, Price’s resignation Friday as HHS secretary could, at least momentarily, force agency heads to tap the brakes on any bold new policies.

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Congress should enact waiver legislation that clarifies the availability of federal subsidies for the purposes of evaluating waivers’ deficit neutrality, including all potential federal spending that could be offset by a waiver, and evaluates its impact over a long (8-10 year) time period after an initial pilot period. Federal “guardrails” to prevent unintended consequences on patient outcomes and the deficit should focus on collecting data on costs and impact on vulnerable populations, while expanding consumer choices around affordable, high quality plan options.
Congress should also instruct HHS to create a set of standardized, expedited waivers that could be quickly approved, to enhance confidence in the process. Congress should also allow states to form multi-state compacts to share costs and develop the necessary implementation infrastructure.
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Republicans have a new promise on health care: It’s not over. As the GOP trumpeted the framework of a new tax overhaul plan at the Capitol on Wednesday, lawmakers wrestled with their message to voters after promises to roll back the Affordable Care Act officially came up short Tuesday. The GOP health-care push “is not going to stop. It’s just that we’re not going to focus solely on that,” said Senate Majority Whip John Cornyn. President Trump said he now expects a bill to pass early next year. He also said he would issue an executive order, likely next week, targeting rules that make it hard for insurers to sell policies across state lines.
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