The trouble with that, of course, is that the world and American views on healthcare are evolving. More and more, it's being considered a civil right. Life, liberty, and the pursuit of happiness kinda has to include health, otherwise you die, your liberties are reduced to just being on paper, and you can't pursue much happiness. Civil rights are really not an issue to be different between states. But, in general, Americans favor universal healthcare. If it were put to a straight popular vote, it would win easily. So, I think the mandate is there. Splitting it up by state just seems impractical.
As a country, we have decided that no one should be excluded "based on cost". That's a very euphemistic term for insurance companies refusing to pay out when their services are actually called upon, by the way. Every person should be covered. Your assertion about blanket policies is also weird. Your point is to impugn a "one size fits all" approach, I assume. But covering everything... that really does fit all. And it can rein in the excesses of the medical industry. So yes, costs go down. Even if we stop refusing to treat people because they're actually sick.