It depends upon the financial responsibility law of the State. In general, each State mandates minimum insurance requirements. These usually relate to Personal Injury Protection Coverage and third party liability. Proof must be shown at the time of registering the vehicle.
If the insurance lapses, once the financial responsibility authorities find out, they can suspend the license and tags of the responsible part(ies). It is also an offence for which one can get a traffic ticket and which, depending on the State, carry a stiff fine and a further license suspension.
If one is involved in a collision without insurance and is found to be At Fault, their license and tags can be suspended until full restitution is made. They may also be required to obtain and maintain high-risk liability insurance for a number of years.
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