Selling Health Insurance Across State Lines

An Assessment of State Laws and Implications for Improving Choice and Affordability of Coverage

Proposals to authorize the sale of private health insurance “across state lines” are often promoted to address the challenges of high health insurance costs and a lack of choice among insurers. They’ve been a core component of alternative health reform proposals since the mid-2000's. To understand the impact of these proposals on the availability of health insurance and the competitiveness of state health insurance markets, researchers at the Georgetown University Health Policy Institute analyzed legislation enacted in six states—Georgia, Kentucky, Maine, Rhode Island, Washington, and Wyoming.

According to the authors, proposals to authorize selling health insurance across states lines do not adequately take into account the complexity of how insurance products are sold and regulated. The proposals underestimate the administrative hurdles necessary for full implementation and as a result—none of the laws allowing across-state-line insurance sales have resulted in a single insurer entering a new market or the sale of a single new insurance product.

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