Insurance companies, like any company, want to make a profit. In order to do so they establish networks of physicians and hospitals and pharmacies and negotiate set prices for the services and goods they will bill the insurance company for. It controls their costs and allows them to gauge their risk and price their product accordingly. I, like all consumers, want to get the best possible service for the lowest possible prices. In order to do so I will prefer to use doctors and hospitals and pharmacies that are in my insurance company network because they tell me ahead of time what I can expect to pay for medical care and doctors visits. That is, I believe, a competitive model that benefits both sides. Or would you disagree?
So if Trump removes the barriers between buying insurance across state lines, where is the benefit to me? Say I find a company in Texas that doesn't currently do business in Missouri, why should I buy from them? You say I might be able to get a lower premium, which may be true. But the insurance company does not have a network established in Missouri; why should they since they have never done business there? Any medical care I get, any claims I file will be "out of network". Using my current coverage as an example my costs go up. Instead of a $15 co-pay for a doctor's visit I will pay 30% of what the doctor charges. Instead of a $1000 deductible I would have $4,000. Instead of a modest co-pay for prescriptions I would pay list price. Instead of having physicals, well-woman exams, mammograms and the like 100% covered I would pay 30% of whatever they cost. In short my costs go from predicable to unpredictable and my out-of-pocket expenses are higher. Why would I want to buy from them?
And from the insurance company's standpoint why would they want to sell to me? They have no network, like I said, so they would have to pay far higher costs for my claims than they would for claims they get from Texas customers. They could establish a network I suppose, but going around Missouri signing up doctors and negotiating prices is an expensive and time-consuming endeavor and why should they go through that for one customer? Their pricing model is based on their known risk; I'm an unknown risk that their insurance premiums don't factor in. So they would have to tailor a premium specifically for me. Given all that then it's highly unlikely that they would make any money off of me, so if I come calling why would they not say "Thanks, but not interested" to my business?
That's why the whole selling across state lines will probably do nothing to lower costs. Several states have examined it, a couple of states like Wyoming and Georgia have tried it, and all failed because of lack of interest on the part of the insurance companies to participate. How do you solve that?
In order to do so they establish networks of physicians and hospitals and pharmacies and negotiate set prices for the services and goods they will bill the insurance company for. It controls their costs and allows them to gauge their risk and price their product accordingly. I, like all consumers, want to get the best possible service for the lowest possible prices. In order to do so I will prefer to use doctors and hospitals and pharmacies that are in my insurance company network because they tell me ahead of time what I can expect to pay for medical care and doctors visits.
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Ah there lies the rub. If providers provide the same price network or not, then healthcare would be affordable, as well as competitive. As a provider, I would find this most attractive.