The Senate bill would allow for things called “nationwide plans.” These plans would be based in one state, and could sell in any other state, while ignoring those other state’s regulations. To quote the bill section 1333:

(b) Authority for Nationwide Plans-
(1) IN GENERAL- Except as provided in paragraph (2), if an issuer (including a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark) of a qualified health plan in the individual or small group market meets the requirements of this subsection (in this subsection a `nationwide qualified health plan’)–
(A) the issuer of the plan may offer the nationwide qualified health plan in the individual or small group market in more than 1 State; and
(B) with respect to State laws mandating benefit coverage by a health plan, only the State laws of the State in which such plan is written or issued shall apply to the nationwide qualified health plan.

It clearly says right there in the bill that Aetna could set up shop in Indiana and sell insurance in New York that only meets Indiana’s lower standards. This could produce a race to the bottom. The worst part is that it is an “opt-out” and not an “opt-in” program. States would not be able to act in time to prevent their regulations from effectively being gutted by “nationwide plans.” Nationwide plans nullify state laws regulating what kinds of health insurance must be sold in their state.