"There are logistical hurdles: It's pretty hard to set up a network of doctors and hospitals that will work for patients in both Iowa and New York."
which might have been a hurdle back in pre-computer days. Today, companies like Premera, Humana, and many others have no problem setting up networks not just within states, but within counties in a state.
Going interstate should be no problem at all.
The problem isn't technical, it's economic.
Insurance companies compete by negotiating discounted contracts with providers - who are generally local or regional players at best.
The higher the volume of patients the insurance company can offer the lower the cost. An out-of-state insurer won't be able to guarantee many patients and therefore won't get nearly as good a price from the provider.
They just won't be competitive.
Because companies like Premera, Humana, Blue Cross, Cigna, and the like are willing to go to the expense of establishing networks of providers. If an insurance company chooses not to then there is no way they would want to sell a policy in a state without one.
I have had Humana for many years. For 2018 they rolled out a new policy that effectively did away with the network system.
I can go to ANY doctor in ANY state and ANY hospital and pay the same costs.
For visits to a GP I pay $15 copay, less than the $20 copay I was paying previously.
My copay for specialists has remained the same, $45 a visit.
For procedures, tests or surgery the costs are a mixture of increases and reductions. If my GP wants an X-Ray I now pay $15 for the visit and less for the X-Ray than previously.
When my neurologist ordered an MRI because I had the worst case of vertigo he had ever seen the MRI ended up costing me $310 compared to the $900+ under the previous policy.
It was an inner ear problem so they sent me to Audiology, $45 for the visit copay and $108 for the test and procedure that would previously cost at least $700.
And they changed their pharmacy by mail. Before my savings would have been negligible so I kept my local pharmacy and paid $93/month for my meds.
Now, since all my meds are generics, my medicines cost $0.00. I go online, request a refill and in 7-10 days it’s delivered to my door.
The amount for Medicare deducted from my monthly benefits did increase by $35 but Humana is no longer deducted so there is a net savings of $70.
My savings in premiums and drug costs is currently $163/month.
A YUGE win for me.
Yeah, national networks are very doable. If the insurance company has the will.