(We are updating this with a few comments made at the summit, and a little more explanation of how the Senate Democratic bill's approach to "across state lines" would work.)
We expected a few issues to be stressed at today's health reform summit -- among them, buying insurance across state lines and malpractice reform. We were right. We've been tweeting all morning, but here are a few thoughts and a guide to some work we've done in the past on these topics.
Across State Lines. Republicans are still pushing the idea of letting people buy insurance across state lines -- an idea we've pointed out doesn't work, at least not how they have historically constructed it. Here’s our report (and also the executive summary) published back in 2008. Our study indicates that allowing insurers to sell across state lines, in the way the Republicans have and continue to propose, would make it harder and more expensivefor many Americans to access quality health coverage. It may benefit some of the young and healthy, but it would have a devastating impact on the insurance market for everyone else (and none of us will be young and healthy forever). It would gut many of the patient protections and state rules now in place, and as President Obama put it, risk creating a '"race to the bottom."
However, the Senate bill does allow states to pool enrollees and form insurance "compacts" (check out the Kaiser side-by-side for more details) permitting the sale of insurance across state lines -- but with oversight, regulations and a mandate. As Senate Finance Committee chairman Max Baucus commented at the Blair House earlier today, "We do allow for that [across state lines]. But not exactly the way some would." Once the exchanges are up, Baucus added, people could buy insurance across state lines and benefit from competition. But there would be rules -- that strengthen patient protections. When the Senate Finance committee first developed its "states' compact" approach, Len Nichols wrote on our blog that it would ensure that insurance market rules would be uniform across state lines, "ensuring that every insurance package provides access to necessary services and protects consumers' health and financial needs."