However, concerns about debt caused that plan to be abandoned, and replaced with a lower-cost plan.

The lower-cost plans would resemble health-maintenance organizations, which provide all care for a preset fee and require use of particular doctors and hospitals.

Washington now allows insurers to offer a lower-cost, lower-benefit plan to individuals and groups of fewer than 25 employees who do not have coverage.

So, he says, they would have a strong incentive to switch to lower-cost plans, and plans would compete for business by offering lower prices, or premiums.

One strategy involved offering lower-cost plans to customers, like the elderly, who use fewer minutes each month but are likely to pay their bills.

That incentive could help pull more people into lower-cost plans.

In Oklahoma, which does not require health insurance coverage, Blue Cross is offering a basic, lower-cost plan.

In the last decade, they have steadily migrated into lower-cost plans.

This is done by limiting employee choice to lower-cost plans like health maintenance organizations and by increasing employee health-plan contributions.

Nor do many workers switch to managed care or other lower-cost plans.