This isn't a new thing, either. Someone told me a story years ago about a patient who had to undergo heart surgery in a major city in the Northeastern U.S. After running the numbers, his insurance company offered him a deal: instead of having the surgery done in the Northeast, they paid him and his wife to spend a couple of months down in Texas at the Debakey Institute for the surgery and recuperation (widely recognized as one of the top medical centers in the U.S. for heart issues). It was actually cheaper for the insurance company to do this than to pay the cost of the procedure near his home.
Take that story and replicate it several million times a year, and you've got a disaster for the medical profession and major hospitals all over "closed shop" union states if organized labor every tries to get into these places.
One idea being floated is to change federal labor laws to prevent states from being right to work states. The unions are pushing for those changes.
Right to work state plus no state 0-care exchange would be the best place for medicine to flourish now. The differences could be amazing. Then if such a state, like TX, enacted some legislation requiring menu pricing, we could see a very competitive, high quality and productive healthcare market emerge in that state. Doctors, wealthier patients, and businesses would relocate to take advantage of better conditions.