Trump and some Republicans have argued for allowing selling policies across state lines but I think more knowledgable people have said it would not make a signi

Trump and some Republicans have argued for allowing selling policies across state lines but I think more knowledgable people have said it would not make a significant difference in health care costs and poses some race-to-the-bottom risks. I think most insurance providers are multi-state entities so higher costs in one state can be balanced by lower costs in others. But there may be some limits; if the ACA requirement that insurers use 80% of revenue on health care costs is applied per-state, they may not be able balance out a really unhealthy state. But this isn't an issue due to America's geographic or population size or even the quantity of states, it's that America has much more political power at the state level.