It means a state, let’s pick on Wyoming, could say, “Fuck medical standards for health insurance!” and their insurance companies would offer the cheapest plans in the country. And everyone would buy those plans because they’re the least expensive.
And then you’d get sick and get billed for everything you’ve got.
“But wait, I’m insured!” you’d cry. But your plan doesn’t actually cover anything but hangnails.
It would just be a race to the bottom.