An American Medical Association study found that one insurer controlled more than half the market in 30 states. “In Alabama, almost 90 percent is controlled by just one company,” Obama told a crowd in 2009. “And without competition, the price of insurance goes up and quality goes down.”
Hit the hardest were rural residents, typically poorer and less healthy than the rest of the country. Metro areas offered the greatest profit, so big insurers and hospital groups had little incentive to compete for the countryside. Absent competition, premiums and hospital prices soared.
Many Democrats pushed for a public insurance plan, which would compete with companies such as Aetna for customers. But Republicans rallied to protect insurers, claiming it was unfair to make them compete with government.
“We shouldn’t have ever called it a public option,” says Kentucky congressman Yarmuth. “We should have called it ‘Medicare for all,’ and then people would have been for it, because ‘public option’ was too vague.”