NCPA - National Center for Policy Analysis


May 6, 2008

During Barack Obama's tenure in the Illinois State Senate, 18 different laws came up for a vote and passed that imposed new mandates on private health insurance.  Obama voted for all of them, says Scott Gottlieb, a resident fellow at the American Enterprise Institute.

Obama now says people lack health insurance because they can't afford it.  He's right.  But he is also partly responsible for why health insurance is too expensive.  Mandates drive up the cost of insurance for the very people priced out of coverage, say Gottlieb.


  • Mandates increase the cost of basic health coverage by 20 percent to 50 percent. depending on the state, according to the Council for Affordable Health Insurance (CAHI).
  • Average policies in high-mandate New Jersey cost about $4,000 according to a 2004 insurance survey, much more than the $1,200 charged in low-mandate Wyoming.

But not all mandates are equally expensive:

  • Drug rehab increases a plan's premiums by 9 percent on average, according to America's Health Insurance Plans (AHIP).
  • Coverage for psychologists adds 12 percent to premiums.
  • But in total, in some states mandates increase the cost of insurance from 10 percent to 20 percent, according to AHIP.

These increased costs aren't shared equally among all who have health insurance.  People who are covered through self-insured employers (usually large corporations) are shielded from state mandates because of the federal Employee Retirement Income Security Act (ERISA), which prevents states from enacting controls on plans that cross state lines.

In total, about half of the people who have insurance bear the brunt of the cost of state mandates.  And, as it turns out, individuals who do not work for large corporations are much more likely to be uninsured.  Between 20-25 percent of uninsured Americans can't afford coverage because of the increased cost of providing mandated care, according to AHIP.

Source: Scott Gottlieb, "Obama's Health Care Record," Wall Street Journal, May 5, 2008.

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