Imagine tuning into a Sunday football game. Amid the flurry of touchdowns and tackles, the commercials are filled with familiar names — State Farm, Allstate, Liberty Mutual, and Farmers — vying for your dollars to cover your cars, homes, and personal liability. You have choices, and the competing advertisements are evidence of a robust marketplace where consumers benefit from price competition and innovation. But imagine if, alongside those ads, you could also shop for your health insurance — across state lines, no different than car or home coverage. Here lies a fundamental problem in American healthcare: you cannot buy most health insurance plans outside your own state. Unlike auto and home insurance, which have broad risk pools and interstate competition, health insurance markets remain balkanized, resulting in fewer choices and higher costs for consumers.
The roots of this uniquely American challenge date back to World War II, when the Franklin D. Roosevelt administration instituted wage and price controls to curb inflation. Employers, competing for talent but unable to boost salaries, began offering health insurance as a fringe benefit — a decision that intertwined employment and insurance in a way that persists today. At the time, it may have seemed like progress, but it has left countless Americans dependent on their employers for coverage. When jobs change, so does coverage, leaving those between jobs exposed and often without affordable options. Those ineligible for Medicaid — because their income is just above the cutoff — are especially at risk for being uninsured.
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