Why are New Yorkers forced to pay more for health insurance than residents of most other states? New York State’s lawmakers are to blame. The good news is that the Health Care Choice Act, offered in Congress by Rep. John Shadegg, a Republican of Arizona, would allow New Yorkers to buy health insurance outside the state for as little as 10% of what they currently have to pay. The bill would free New Yorkers from the mandates and community rating laws that have made health plans sold in New York State so expensive.

Imagine a state law that says the only car you can buy is a luxury model loaded with options. That’s exactly what mandates in New York have done to health plans. Year after year, state legislators have added new coverage requirements, everything from acupuncture to well-child care. Health care advocates want every possibly beneficial treatment and test covered, and medical interest groups – like podiatrists, chiropractors, and optometrists – lobby aggressively in Albany to ensure that every health plan covers their services.

What should be covered by health insurance is, of course, an emotional issue. Families involved in the trauma of drug abuse want drug treatment covered. Childless couples want in-vitro fertilization covered. It’s easy to forget who pays for these extra services: generally, those who can least afford them.

Large multi-state companies don’t have to obey state insurance mandates. They “self-insure,” and decide what coverage their workers receive. So who bears the cost of state mandates? The self-employed, as well as people who work for mom-and-pop grocery stores, dry cleaners, and other small businesses. When mandates make insurance too costly, these are the people who become uninsured.

In New York over the last few years, there’s been a face-off between advocates of affordable health insurance and lawmakers pushing for more mandates. Under a few circumstances, New York law now lets some small businesses buy a “streamlined” health plan without all the mandated options. But, for the most part, mandates are increasing.

In addition to mandates, New York’s community rating law has also made health insurance unaffordable. Community rating means that health insurance cannot be sold to young people at a lower price than to older people. A 25-year-old man uses, on average, about one-third as much health care as a 55-year-old man, but in New York the younger man and the older one pay the same premium. That makes health insurance a bad buy for the younger man, who generally also has a lower income. That’s one reason that people ages 18-24 are the group least likely to be insured in New York. New York lawmakers are not about to change the community rating law? Why? Because it benefits older people, who are more likely to vote than younger people.

New Yorkers are paying a huge penalty for their insurance laws. To see how big, go to www.ehealthinsurance.com (or one of the other Web sites that list health plans). Type in your gender and age, but instead of typing in your New York zip code, type in a zip code for a town in Indiana or Connecticut. You’ll see that if you lived in one of these other states, you could buy a health plan for as little as a tenth of what you’re paying for coverage in New York.

The Health Care Choice Act would allow New Yorkers to buy insurance outside their state without actually moving. The bill would create a national market for individual and small group health insurance. President Bush endorsed the bill in his recent State of the Union message.

Opponents of the bill argue that New York’s mandates protect you from buying a health plan that doesn’t include everything you should have. Incredibly, there are people who defend buying prescription drugs in Canada but say that buying health insurance in Connecticut would be too dangerous.

The best answer to their objections is that families and small businesses shopping for health plans should have the choice of buying a no-frills policy without all the mandates. Some insurance is better than no insurance. Driving is better than walking. And New York should allow health insurance to be priced fairly for the young. Call your member of Congress to say you want the freedom to buy affordable health insurance wherever it is sold.

Ms. McCaughey is a former lieutenant governor of New York State and chairman of the Committee to Reduce Infection Deaths (www.hospitalinfection.org).