How can health insurance be interstate commerce if it is not allowed by Congress itself to be sold across state lines?

States have regulated health insurance since the 1945 passage of the McCarran Ferguson Act, which, among other things, forbids interstate sale of insurance (health, auto, homeowners). States have regulated insurance ever since. Many insurance companies sell policies in different states but each is a separate company per state, and in doing so, must comply with a given state's regulations.

Some already purchase health insurance across state lines. The ERISA Act of 1974 allows businesses that self-insure their employees to include all employees in one health insurance pool, even if they live in different states. Self-insurance means that the company is responsible for paying the health expenditures of its employees after the employees have paid the specified deductibles and co-pays. Such companies typically hire an insurance company to process claims and are predominantly large employers who have chosen to self-insure to remove the insurance middleman. But why is third party payment by an employer allowed in the first place?

The fact is that true capitalism has never played a part in health insurance because of government intervention.  Government intervention is the problem that drives up costs.  Government intervention in the form of interstate commerce prevention and employer benefit income tax laws.  The non-payer cost factor is a side show compared to this true integral that drives up cost:  the moral hazard of government tax law policy with employee benefits.