2. If an insurance company must cover a pre-existing condition, then it's not really insurance.
Item #2 can be addressed through high risk pools as you said, or through an idea I've considered for some time where insurance carriers would be obligated to share risks for "pre-existing conditions" as defined by their own policies. In other words ... Suppose I have insurance through Company A and I have a serious medical condition, then my employer moves to Company B. Company B should not be forced to cover every expense associated with my "pre-existing condition," but Company A should still be on the hook for part of my expenses through a re-insurance market of some kind. I would think this sort of thing can easily be worked out in state regulations.
That's not operating "across state lines." Blue Cross/Blue Shield of Iowa cannot sell or administer health care plans in Illinois, for example. Operating across state lines would mean that BC/BS Iowa could sell in all 50 states, not just Iowa. (Ever wonder exactly why there's a BC/BS in all 50 states and not just one?)
If an insurance company must cover a pre-existing condition, then it's not really insurance.
Yes, it is insurance. I've had four major lower back surgeries, the last one almost ten years ago now. What's the likelihood I'll need lower back surgery number five anytime soon? That's a risk and healthcare insurance is all about risk pooling. Healthy people are lumped in with sick people all the time, happens in every Company across America.
Why is it I can go from job to job and maintain coverage for a "pre existing condition" and then upon losing my job, cannot buy healthcare insurance to cover that same condition out on the open market?
That's a big problem and needs to be fixed. Again, whether it's a big risk pool, high risk insurance pool or some other solution that's fine, as long as those with pre existing conditions can get coverage.