Since state laws are what stand in the way of out-of-state insurers selling health insurance in a state's market, a state can rescind those restrictions at any time. A few are in the process of testing that out. Like Georgia, which will now license insurers from any state and allow their plans to be sold in its market, even if those plans don't comply with the consumer protections in Georgia law. It's only been a few months but so far there aren't any takers. No out-of-state insurers offer plans in Georgia | The Atlanta Journal-Constitution The standard thought process from the "dumbfounded" folks seems to be 1) maybe it's Obama's fault, and 2) maybe Georgia didn't deregulate enough. My own suspicion is that the larger concerns are that 1) the individual health insurance market is small (~5% of the U.S. population and the same percentage of Georgia's population) and 2) building adequate provider networks (with reasonable reimbursements) is going to be challenging in a state you're not in, particularly when you have no customers to offer. But it's early.