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    Obamacare Repeal: What May Replace It

    High-Risk Pools continued...

    They lost money anyhow -- more than $1 billion annually for the 35 state-based programs combined. The high-risk program run by the federal government lost more than $2 billion before closing shop. If new high-risk pools stand any chance at success, Blumberg says, they’re going to need a lot of funding.

    “If you take sick people and separate them off from healthy people and give them meaningful coverage, it will cost a boatload of government dollars to do it.”

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    Selling Insurance Across State Lines

    Historically, state governments have regulated insurance companies. Firms that wish to do business must get a license and follow that state’s specific rules. Before the Affordable Care Act became law, there was quite a bit of variation in those rules from one state to another. The law helped to make those rules more uniform.

    Trump has proposed loosening existing federal requirements to make it easier for health plans to sell insurance without having to comply with the specific rules of each state in which they choose to do business.

    Pros: Allowing insurance companies to sell health care plans across state lines would increase competition among insurers and do away with requirements that drive up costs. Consumers are also likely to have more choice in the variety of insurance products than they do now under the Affordable Care Act.

    “You get rid of the lines, it brings in competition. So, instead of having one insurance company taking care of New York, or Texas, you'll have many,” Trump said in February during the CNN-Telemundo Republican debate.

    Cons: Selling insurance across state lines is unlikely to save consumers money and may raise costs.

    Ed Haislmaier, senior research fellow with The Heritage Foundation, points out that 80% to 90% of insurance premiums are paid to the doctors and hospitals that provide medical care. If you live in Los Angeles and buy a plan in Arkansas, for example, you’ll still end up paying California rates to the doctors there.

    The ultimate cost of insurance won’t be dissimilar to a California-regulated plan, Haislmaier says.

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