I was hoping this thread would start a good discussion on this topic. I may (or may not) know a thing or 2 about it. Lot of good posts so far.
First thing I tell everybody, the ACA's biggest problem was that the word AFFORDABLE is in it. There is noting affordable about healthcare. Its expensive. It sucks, but thats the way it is. Fixing the cost of healthcare isn't just an insurance problem. You have to work with the docs, hospitals, tech companies, drug companies, etc. Problem is there is a large segment of the population that is used to the 80s and 90s when a) companies paid a lot more of the share of premium than they do now and b) benefit plans were made so that it would only cost a $5 copay for an office visit, $10 for a ER visit, and $100 for an inpatient stay.
Second, "selling across state lines" is total political BS blustering that means nothing. You live in NJ and want to buy a BCBS Nebraska plan because it is cheap? Then go right ahead, but all of your in-network doctors are in Nebraska. And if BCBS Nebraska were to start selling in NJ, then it would cost just as much (if not more) as your local plans because they would have to negotiate a network in NJ.
I will add in more thoughts throughout the day as I have more time...