Could Obamacare Be Repealed?

Posted on October 9, 2009. Filed under: health care | Tags: , , |

By Stephen Spruiell

In the early 1990s, eight state governments imposed “guaranteed issue” and “community rating” regulations on health-insurance companies operating in their states. Guaranteed issue means that insurance companies cannot deny coverage except in rare cases, such as those involving fraud. Community rating means that insurance companies are restricted in their ability to charge higher rates based on things like gender, age, or medical history. All the versions of Obamacare being debated in Congress would impose guaranteed issue and community rating on the nation.

The effect of these reforms at the state level is no longer a matter for debate: In each case, insurance premiums skyrocketed; healthy people stopped buying insurance; and insurance companies exited the market in droves. Each state government was forced to take corrective action. Yet, while three state governments possessed the good sense to repeal or weaken their guaranteed-issue and community-rating requirements, the other five papered over their failures with inadequate, short-term fixes.

What accounts for the difference? In Kentucky, New Hampshire, and Washington state, conservative Republicans were able to find footholds at key moments and repeal or weaken the requirements. In New York, New Jersey, Vermont, Maine, and Massachusetts, the political culture proved inhospitable to calls for market-based solutions.
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