Conservative Healthcare and Insurance Ideas?

Greg Sargent reports on the prospects of further reform to insurance and healthcare policy, now that the full range of benefits of the Affordable Care Act have kicked in and more and more people start to use them, making outright appeal more and more difficult.

According to Kaiser Family Foundation Larry Levitt, one possibility for a policy change both sides could embrace, assuming that "Republicans do get to a point where crippling or eliminating the law is not the only acceptable outcome," is "allowing insurance sales across state lines... if the law's uniform federal minimum coverage standards are kept".

This would indeed be a great improvement to the law, but let's not pretend that it's a newly suggested proposal that liberal proponents of the law haven't supported in the past, or that it's a conservative idea that liberals would only accept for a trade.

Sure, you hear conservatives talk specifically about 'buying insurance across state lines' more than liberals, but remember that the original marketplace exchange proposal supported by liberals and President Obama was a single national one, not many state-based ones.  This would have been identical to allowing the purchase of insurance policies across state lines with standards determined by the federal government.  The only reason the final bill went with many state-based exchanges instead a single national exchange was as a compromise to conservatives, especially Democratic conservatives from rural states, who could argue that this better respected federalism and states' rights.  So maybe file this one under 'conservatives can only accept a proposal when (they think) they've come up with it'.

Of course, the rest of this story of national-vs-state-based exchanges goes that even with the settling on state-based exchanges (enabling some markets to adopt a lower, more conservative-friendly level of insurance regulation), most conservative states opted for the national exchange anyway, despite likely ending up with more liberal policies than had they built an exchange and regulated it themselves.  In the spirit of intellectual charity, maybe instead of immediately accounting for this fact by pointing to conservative obstinance, it should be considered that this has something to do with the preference for deontological ethics over consequentialism among conservatives?

Similarly, in another example of conservative ACA-opponents likely not understanding the law, during the legislative process of writing the law, conservatives fought to limit the extent of the marketplace exchanges as much as possible, while liberals wanted as many people as possible in the exchanges, to maximize the value of participating to the insurers and maximize the consumers' bargaining power.  The liberals ended up compromising for conservative votes, so that only those without employer-sponsored insurance went to the exchanges for coverage.  This means that Members of Congress and their staffs, who all have insurance from their employers, would have gone to the exchanges under the liberal plan, but it was the compromise with conservatives that kept them out of it, which undercuts the current conservative claim that they want all health insurance consumers to be treated equally.