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I'm going to resist injecting my opinions into this post as much as possible and address some of the factual issues with the hopes that it will foster the conversation.
The state-by-state regulatory system that we have wasn't really designed. It developed over a period of time. The federal government never really sought to provide much oversight until about 20 years ago. That goes for health, life, property/casualty and all the other lines.
The large companies already operate across state lines, pretty much with impunity. For instance, even though I live in Illinois, my health insurance carrier is Blue Cross/Blue Shield of [southern state]. The BC/BS company has to follow IL laws here, but so long as they are filed to do business in the state, they are allowed to do so. This is done because my company's corporate headquarters are in the unnamed southern state and is an unusual arrangement.
What the Republicans propose that is different than the current system is to allow smaller companies to use brokers to seek the best coverage ("best" being a qualitative term defined by the buyer) available in the entire nation rather than the local companies. The prospective carriers would still need to be filed and authorized to transact business in that state (no mean feat in some states since it can take years in spots), so buyers could potentially access all points of a larger network.
Health insurance costs are already localized, but costs from area to area generally do not vary too much, at least in terms of hospital care (which is the big ticket item) because the local health insurors have negotiated those prices downwards already. There is more variance in office visits, especially with specialists.
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"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - B. Franklin
"There ought to be limits to freedom." - George W. Bush
"We have met the enemy and he is us." - Pogo
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