If the rule is cannot deny coverage, high risk people will buy the cheap policy and then switch when they need the expensive benefits. For that matter low risk

If the rule is cannot deny coverage, high risk people will buy the cheap policy and then switch when they need the expensive benefits. For that matter low risk people will switch if they roll snake-eyes and need to schedule something expensive like reconstructive surgery. This is essentially the same adverse selection logic that justifies the mandate. * People choosing to buy or not buy insurance has gotten reframed, and I find it interesting to see how effectively the switch took place. In 2008, your hypothetical 25 year old would have been portrayed as a victim, if anything. Screwed over by the greedy health insurance companies who make it impossible to get decent coverage at a reasonable price. In 2010, he's the bad guy. It's his fault the system is broken. He is morally obligated to buy that health insurance now, and if he argues that he's getting a crappy deal for what he is paying, it's him who is being selfish and greedy. There are certainly identity politics tangled up in health care reform, but I was talking about the reframing of an issue and fickle public opinion.