The Republican Study Committee is the policy group of the most conservative Republicans in Congress. They have a health insurance bill out and there is a lot to say. I only want to highlight one item though in Section 401:
‘‘SEC. 2796. APPLICATION OF LAW.
‘‘(a) IN GENERAL.—Subject to section 601(d) of the American Health Care Reform Act of 2017, the covered laws of the primary State shall apply to individual health insurance coverage offered by a health insurance issuer
in the primary State and in any secondary State, but only if the coverage and issuer comply with the conditions of this section with respect to the offering of coverage in any secondary State.
‘‘(b) EXEMPTIONS FROM COVERED LAWS IN A SECONDARY STATE.—Except as provided in this section, a health insurance issuer with respect to its offer, sale, rating (including medical underwriting), renewal, and issuance of individual health insurance coverage in any secondary State is exempt from any covered laws of the secondary State (and any rules, regulations, agreements, or orders sought or issued by such State under or related to such covered laws) to the extent that such laws would— (My emphasis)
‘‘(1) make unlawful, or regulate, directly or in directly, the operation of the health insurance issuer
operating in the secondary State, except that any secondary State may require such an issuer—
That one sentence effectively forecloses any Blue state solution that relies at all on the individual market. It blows up the Massachusetts model for if an insurer can register in New Hampshire as its primary state, it can sell across the border into Massachusetts where it offers medically underwritten policies with significant benefit carve-outs such as no maternity coverage. The Massachusetts risk pool will become extremely sick or extremely likely to be pregnant. That will significantly raise premiums and death spiral the non-subsidized and lightly subsidized portions of the three legged stool market.
Blue states can experiment under this law only in ways in which they will allow themselves to be subject to regulatory capture and race to the bottom of standards.