Also, a big reason that ACA plans cost more in red states is because most of them refused the Medicaid expansion. So the insurance company actuarials working in those states had no choice but to forecast higher healthcare costs for everyone based on the predicted number of poor people receiving care at hospital ERs but being unable to pay for it.

Then add on the higher average rates of obesity, diabetes and tobacco usage in red states and you’ve gone a long way towards explaining any disparities you may be noticing.