It's a longstanding conservative goal to increase competition in health insurance. In many states, especially if you're buying a policy on your own, there's only one carrier. Donald Trump said he'd change that, by getting rid of "the artificial boundaries" of state borders.

The greatest progress he made as president was through a new regulation that eased restrictions on what are called association health plans. These are plans offered by organizations with business members from different industries but located in the same state, such as chambers of commerce. Or people and firms in the same line of business, such as the real estate or restaurant industries, could offer plans to self-employed workers in those fields.

Under the rule, key requirements from Obamacare remained in place. Insurers couldn't deny coverage or set premiums based on a person's health, including any pre-existing condition. Plus, there could be no annual or lifetime caps on covered services. But insurance plans wouldn't need to offer the standard package of health benefits mandated in the Affordable Care Act.

A group of 11 states plus the District of Columbia sued to block the rule, and in March 2019, a federal district court judge agreed, saying the rule was "an end-run around the Affordable Care Act."

The Trump administration has appealed. If it wins, the number of these plans is expected to grow. The Congressional Budget Office projected that more than 3 million people could ultimately be covered under these association type plans.

But even if that happened, a key piece of the promise would go unfulfilled.

States still have the authority to regulate the insurance plans within their borders. The lines are still in place. 

Chris Condeluci, a former Republican Senate staffer and consultant to groups using the new rule, told us he hasn't heard the administration talk about reaching this goal in at least two years.

"This seems to be an old and cold talking point that this administration has abandoned because it is virtually impossible to make this policy change into a reality," Condeluci said.

Health law professor Timothy Jost at Washington and Lee University said insurance companies face a patchwork quilt of state policies.

"States remain the primary regulators," Jost said. "But some states don't exercise their authority, and others let a lot slip through the cracks."

In either case, the lines remain.

We rate this a Promise Broken.