I respectfully disagree - I think the biggest change the law enacts is the cap on the MLR. Telling insurance companies they have to cover those with pre-existing conditions doesn't make them want to cover those with pre-existing conditions, it just makes them not want to be sued for one more thing. That is no kind of motivation to keep costs down or provide decent service - if Joe Sicko says "screw this, I am going to your competition" they break out the champaigne. With the MLR cap, having one more person means they can take home more money, so long as they're operating near the cap to begin with.