---
kind: "section"
citation: "42 U.S.C. § 18053"
title: "42"
title_heading: "The Public Health and Welfare"
number: "18053"
heading: "Provisions relating to offering of plans in more than one State"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/18053"
units:
  - "Chapter 157 — Quality, Affordable Health Care for All Americans"
  - "Subchapter III — Available Coverage Choices for All Americans"
  - "Part D — State Flexibility To Establish Alternative Programs"
---

# §18053. Provisions relating to offering of plans in more than one State

- (a) **Health care choice compacts—**
  - (1) **In general—** Not later than July 1, 2013, the [Secretary](/usc/42/18024.md?p=c) shall, in consultation with the National Association of Insurance Commissioners, issue regulations for the creation of health care choice [compacts](/usc/42/2021b.md?p=4) under which 2 or more [States](/usc/42/18024.md?p=d) may enter into an agreement under which—
    - (A) 1 or more [qualified health plans](/usc/42/18021.md?p=a-1) could be offered in the [individual markets](/usc/42/18024.md?p=a-2) in all such [States](/usc/42/18024.md?p=d) but, except as provided in [subparagraph (B)](#a-1-B), only be subject to the laws and regulations of the [State](/usc/42/18024.md?p=d) in which the plan was written or issued;
    - (B) the issuer of any [qualified health plan](/usc/42/18021.md?p=a-1) to which the [compact](/usc/42/2021b.md?p=4) applies—
      - (i) would continue to be subject to market conduct, unfair trade [practices](/usc/42/17061.md?p=19), network adequacy, and consumer protection standards (including standards relating to rating), including addressing disputes as to the performance of the contract, of the [State](/usc/42/18024.md?p=d) in which the purchaser resides;
      - (ii) would be required to be licensed in each [State](/usc/42/18024.md?p=d) in which it offers the plan under the [compact](/usc/42/2021b.md?p=4) or to submit to the jurisdiction of each such [State](/usc/42/18024.md?p=d) with regard to the standards described in [clause (i)](#a-1-B-i) (including allowing access to records as if the insurer were licensed in the [State](/usc/42/18024.md?p=d)); and
      - (iii) must clearly notify consumers that the policy may not be subject to all the laws and regulations of the [State](/usc/42/18024.md?p=d) in which the purchaser resides.
  - (2) **State authority—** A [State](/usc/42/18024.md?p=d) may not enter into an agreement under this subsection unless the [State](/usc/42/18024.md?p=d) enacts a law after March 23, 2010, that specifically authorizes the [State](/usc/42/18024.md?p=d) to enter into such agreements.
  - (3) **Approval of compacts—** The [Secretary](/usc/42/18024.md?p=c) may approve interstate health care choice [compacts](/usc/42/2021b.md?p=4) under [paragraph (1)](#a-1) only if the [Secretary](/usc/42/18024.md?p=c) determines that such health care choice [compact](/usc/42/2021b.md?p=4)—
    - (A) will provide coverage that is at least as comprehensive as the coverage defined in [section 18022(b) of this title](/usc/42/18022.md?p=b) and offered through Exchanges established under this title;[^1]
    - (B) will provide coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title[^1] would provide;
    - (C) will provide coverage to at least a comparable number of its residents as the provisions of this title[^1] would provide;
    - (D) will not increase the Federal deficit; and
    - (E) will not weaken enforcement of laws and regulations described in [paragraph (1)(B)(i)](#a-1-B-i) in any [State](/usc/42/18024.md?p=d) that is included in such [compact](/usc/42/2021b.md?p=4).
  - (4) **Effective date—** A health care choice [compact](/usc/42/2021b.md?p=4) described in [paragraph (1)](#a-1) shall not take effect before January 1, 2016.
- (b) **Repealed. Pub. L. 111–148, title X, § 10104(p), Mar. 23, 2010, 124 Stat. 902—**

## Footnotes

[^1]: See References in Text note below.

## Source credit

(Pub. L. 111–148, title I, § 1333, title X, § 10104(p), Mar. 23, 2010, 124 Stat. 206, 902.)

## Notes

### Editorial Notes

### References in Text

This title, where footnoted in subsec. (a)(3)(A) to (C), is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

### Amendments

2010—Subsec. (b). Pub. L. 111–148, § 10104(p), struck out subsec. (b) which provided authority and requirements for health insurance issuers to offer nationwide qualified health plans.