But with premiums continuing to climb, the market regulations are increasingly becoming an empty promise, said Scherzer, the consumer attorney. "You have to be incredibly sick to make it worthwhile," he said.
Obama and congressional Democrats tried to head off the problem confronting New York by including a requirement in their healthcare legislation that nearly all Americans buy insurance.
This so-called insurance mandate alone would not guarantee lower premiums, many experts concede. Insurance rates in Massachusetts, which included a mandate in its landmark insurance overhaul in 2006, remain relatively high.
But there is broad consensus that a mandate would encourage younger and healthier people to buy insurance, spreading risk more broadly and ultimately helping to restrain the growth of premiums.
New York's largest insurer, Empire Blue Cross Blue Shield, a division of WellPoint Inc., has calculated that a mandate could bring down premiums 50% to 60%, Empire President Mark Wagar said.
But the mandate has become one of the most controversial elements of congressional Democrats' healthcare bill, and a reason why the bill is so expensive. Most experts believe that if the government requires everyone to buy insurance, it must provide subsidies for low-income consumers.
Now, Republicans and some Democrats are pushing to remove the mandate.
Before they do, they should look north, said Courtney Burke, who directs the Health Policy Research Center at the Rockefeller Institute of Government in Albany, N.Y.
"They could learn from New York's experience," she said. "If you don't have some kind of incentive for people to participate, you are going to have problems."