Americans generally do not approve of collusion and conspiracy in corporate America. Big industry conglomerates banding together to fix prices and control entire sectors of the economy is not considered being a good corporate citizen. For these reasons, America has anti-trust laws that seek to prevent these sorts of monopolies from being established in almost every industry, save one: health insurance. Health insurance companies are exempt from federal anti-trust laws and have become what anti-trust laws seek to prevent: a monopolistic industry in collusion.

Provisions of the 1945 McCarran-Ferguson Act provide anti-trust immunities for insurance companies, which protects them from anti-trust enforcement. McCarran-Ferguson did some good things as well, like ensuring that states are the primary regulators of insurance companies versus the federal government. As a result, even with anti-trust immunities, virtually every state in the nation has banned insurance companies from collusion in its jurisdiction. So why repeal federal anti-trust exemptions for health insurance companies? Because a national health insurance market, which will break-down barriers to buying healthcare insurance across state lines, is a critical component of a free-market driven healthcare plan. If Congress passes a law that opens-up competition across the country, and doesn’t repeal federal anti-trust exemptions for insurance companies, those companies may be legally allowed to collude and fix prices, which would defeat the point of a national health insurance marketplace: driving down costs.

The replace bill Congress introduced this week, while certainly making many improvements to Obamacare, still does not go far enough in restoring free-market principles to the healthcare marketplace. A full repeal of Obamacare ought to be passed, and then a replacement bill that opens-up a national insurance market, provides tax credits for families to buy insurance, and which rolls-back onerous mandates on insurance companies, in terms of what they must cover, should be passed. By taking these significant steps Congress can begin bending-down the price curve for healthcare, instead of simply slowing the growth of costs, for American families and the federal government.

Repealing anti-trust exemptions for health insurers is a necessary step toward reviving America’s healthcare system. Free-market competition from coast-to-coast is a critical component of containing costs, and McCarran-Ferguson’s insurance exceptions must be repealed before that is possible. The national nightmare of Obamacare is almost over, but let’s make sure conservative reform actually cuts costs, increases access, and improves care quality. Anything short will replace the nightmare of Obamacare with the bad dream of Trumpcare.