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The Washington Post had a piece that looked at the experience of Washington State to see what might happen with President Obama's health care plan if the mandate is struck down. Washington State provides an interesting model because it had established a similar model of health care reform in the early 90s.
While the initial plan did have mandates, these were never put into law. As a result, people could opt to not buy insurance until they actually had serious medical problems. Many people went this route, which soon made insurance unaffordable since only sick people were buying insurance.
The state responded by allowing insurers to not cover pre-existing conditions, however they still had to take all applicants and charge the same amount. The piece implies that the net effect has been a failure for the people of Washington State, telling readers:
"Washington state’s insurance market now has nine companies selling individual policies, compared with the 19 that participated in 1993. Thirteen percent of Washington state residents currently lack health coverage, the same proportion as when the health reform experiment started."
These comments ignore the larger national trends. There has been enormous concentration in the insurance market everywhere over the last two decades, with 2-3 insurance companies accounting for the vast majority of the market in nearly every state. It is not clear that Washington has fared any worse than other states in this area.
If Washington has been able to keep the percentage of the population without insurance at 13 percent it has done better than the rest of the country. Nationally, the percentage of uninsured rose from 15.0 percent in 1993 to 16.3 percent in 2010, the most recent year for which data is available. While its health insurance law may not be the reason, Washington States has fared somewhat better than the country as a whole by this measure.
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