Trump idea to expand health care competition faces hurdles

While supporters of the idea cast it as a way to make insurance policies more competitive, critics say it's unlikely to result in more affordable plans and could undermine stronger consumer protections in states such as California and Hawaii.

The Trump proposal on cross-state sales would "eviscerate the ability of state legislatures and state governors to decide what the appropriate consumer protections are for their state's consumers and businesses," said Dave Jones, a Democrat who regulates some of California's health plans as the elected insurance commissioner.

"Premiums really reflect the cost of care where an individual lives," said Barbara Klever of the American Academy of Actuaries, a professional group that represents experts who advise on health care and pension programs.

Economist Joe Antos of the business-oriented American Enterprise Institute, said the idea of cross-state health insurance has an instinctive appeal because Americans have seen competition drive down costs in other areas, from credit cards to air travel.

Concerned that repealing the Affordable Care Act would eliminate consumer protections, Democratic lawmakers in some states, including Hawaii and Nevada, have introduced legislation to preserve the act's consumer protections in state law.

Cross-state insurance is popular with conservative lawmakers who believe extensive state-level regulations require people to buy coverage they don't want or need and drive up costs for consumers, particularly those who are young and healthy.

A legislative referee called the Senate "parliamentarian" will make the final ruling on whether cross-state insurance can be considered under the special procedures that require only 51 votes to pass legislation.