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History shows reform fails without mandate

The worst-case scenario for insurers in the Supreme Court review of the U.S. health care law -- eliminating the mandate that everyone have insurance while other changes remain intact -- has been tested in states such as New York, Maine and Vermont.

It failed, insurers say.

The three states were among nine in the 1990s that tried to force insurers to sell policies to anyone who asked, regardless of health, without also mandating that other residents maintain coverage. As a result, as many as 90 percent of those under age 30 dropped their plans, knowing they could always pick them back up if they got sick. Premiums in some cases doubled.

By last year, six of the nine states had repealed the laws, according to Blue Cross & Blue Shield Association, a federation of insurers in Washington.

Several results could come from the Supreme Court hearings ended last week. The justices can approve the law entirely, or they can knock it down. They can also slice it up, severing one or both of the provisions challenged as unconstitutional by 26 states.

Ana Gupte, a Sanford C. Bernstein & Co. analyst in New York, said decoupling the mandate from the insurers' obligations to cover everyone may be the least likely scenario. Jason Gurda, an analyst at investment bank Leerink Swann & Co. in New York, went a step further and predicted the mandate would survive.

"The most likely scenario of the law, post-[Supreme] Court scrutiny, is the bad stuff goes and the good stuff stays," Gupte said in a note to clients. "The stocks should see a continued upward trajectory into the year."

If the court throws out the entire law, earnings potential for insurers might be increased, she said. The industry doesn't prefer that outcome because of uncertainty about what Congress might do next, she said.

The least likely outcome -- striking the mandate while leaving intact requirements that insurers cover all applicants -- would shave about 10 percent from future earnings for top insurers including UnitedHealth Group and WellPoint, a result that "would still be manageable," Gupte said.

Consumers also have a financial stake in the decision, said Ron Pollack, executive director of Families USA, a health consumer advocacy group in Washington. Knocking out the mandate may push them into a situation where they would be dealing with a "crazy quilt" of state-by-state health plans that differ on costs, coverage and scale, he said.

In New York and New Jersey, which didn't repeal their guaranteed-issue laws, insurance premiums have risen faster than the national average, according to a Bloomberg Government study published March 16. In New York's Bronx County, the least expensive family plan in March cost $3,150 a month, according to the state's Financial Services Department.

Vermont also hasn't repealed its law. There, just two carriers actively sell policies to individuals in the state, said David Mannis, a spokesman for the Vermont Department of Banking, Insurance, Securities and Health Care Administration.