Is there anything preventing people from buying plans across state lines other than the insurance companies themselves?
Having to jump through all those hoops will mean you need a few dozen employees minimum dedicated to compliance in that state etc.
But we can overcome that by having the federal government regulate interstate insurance, likely making these companies only needing to comply to the rules of their home state, or by having states set up agreements to allow out of state insurers sell under the rules of the other state.
Only a few states currently do that. Even then nobody is using this ability to sell health insurance interstate. And the reason why is:
You also need to develop a network in the other state, which can be a significant factor in costs. There is no way that you will get hospitals and doctors offices in New York to accept the same small amounts that you can get hospitals and doctors offices to accept in some low cost of living flyover state.
Of course if you do agree to the higher prices that New York providers would charge, well now your average costs have shot up, so you need to raise your rates, making your cheap insurance not as cheap anymore.
In terms of HSA’s, I think they are a great idea.
But I have a more radical solution than an HSA:
Allow the first $100k of income to be contributed pretax to a unified savings plan. We would do away distinctions between 529, ira, 401k and HSA. It would just be a unified account. You could withdraw prior to 59.5 to cover health, education and first home purchases up to any amount. Anyone (employer, family member, friend, charity) could match up to 100% of whatever you contribute in a year into the account. Cash and stock contributions would be accepted. There would not be a minimum age to participate - anyone with a ss#.
Like I said, there are holes in the above - I’m sure with some thought they could be addressed. The general idea would be to turbocharge personal savings and create a unified structure that helps one build and protect a savings account with utility beyond just retirement.