Five states have passed laws allowing residents to buy health insurance from out of state companies not registered in their state - Georgia in 2011, Kentucky in 2012, Maine in 2011, Wyoming in 2008, and Rhode Island in 2010. Some had restrictions, Rhode Island required the company to at least be doing business in New England, but for the most part any company licensed in another state was allowed. To date, not a single policy has been sold to any of the citizens of any of the states. If that isn't failure then what is it?
Such a transaction makes no sense for either party. For the insurance company, they have no network set up to control their costs so they have to pay whatever the service provider charges. Unless the insured makes zero claims then there is no way that they can make money charging those out-of-state customers the same premium they charge their in-state customers. For the insured, every doctors visit they make is out-of-network so they pay higher co-pays, a higher deductible, and a larger percentage of the total bill than they would if they had a policy from an in-state provider. Given that where is the incentive for either party?
That is hardly an example of real competition across the entire country. Texas has made some real progress on deregulation and shown just the opposite until Obamacare destroyed the insurance industry.