[Still Thinking]

Tempt/coerce citizens and employees (with fines lower than their current insurance rates) to dump private plans and go to state “lower costing” co-ops which will make private health plans raise their rates and go out of business. Gov’t becomes the only player in town.

But in that scenario, how can the government stop offshore insurers from arising and offering plans where premiums are claims are paid online?

[Lmo56]

... how can the government stop offshore insurers from arising and offering plans where premiums are claims are paid online?

Couldn't stop it [initially], but could subsequently make it illegal to do so by passing a new bill outlawing it ala Internet Gambling ...

[Tublecane]

“But in that scenario, how can the government stop offshore insurers from arising and offering plans where premiums are claims are paid online?”

I think you answered your own question. Arrest the internet!