Insurance is controlled by state insurance commissions. Sale of insurance products is licensed state by state which is kind of silly.
The main reason is if you look at how auto insurance, property insurance and life insurance is sold those companies are typically not HQ’d in the state they’re writing policies for and it’s interstate commerce anyways.
Even in Pennsylvania health plans are written on a county by county basis. What’s big in Pittsburgh or Philadelphia is different and isn’t even sold in the opposite city. The commonwealth paid for insurance for the poor and uninsured (Funny how we have that funded here as part of the tobacco settlement.) has like 6 different zones with probably 20 different plans.
I would prefer state control over things but anything financial related with insurance products crosses state lines regardless.
Well, actually, I think the insurance company normally forms a subsidiary in each state it sells in. Regardless, they have to comply with each state's regulations. Those regulations include: minimum requirements for policies, proof that the insurance company has enough assets that they can pay off on the policies they have written, brokers that meet licensing requirements, etc.