Crossing State Lines Is No Easy Jaunt for Insurers and Local Regulators - WSJInsurance executives question how much interstate sales would unleash competition. Premiums are closely tied to underlying costs, such as rates paid to local doctors and hospitals and projected health needs of enrollees. The regulatory environment notwithstanding, selling coverage in any given state would require an insurer to have a local network of allied doctors and hospitals, something new entrants to a market might find costly to arrange. “In order to offer more value, you will need to have relationships and contracts with the providers in a state,” said Paul Markovich, chief executive of Blue Shield of California. Insurers almost certainly wouldn’t sell coverage at the same price in multiple states, said Jim O’Connor, a principal at consultants Milliman Inc. They would adjust rates to reflect costs in each location, even if all the policies were under the same regulatory regime, he said.