The combination of these three reforms--insurance market regulations, a coverage mandate, and tax credits--enabled Massachusetts to drastically reduce its uninsured rate.
The quote is from the preamble, and sets out the crux of the matter: cover everyone, and charge equally. Note that this is in contravention to the scam being played by some auto insurance companies these days, where they spy on your driving and charge differently. The notion of insurance is shared risk, and when contravened, is little other than pre-paid consumption, not insurance. The companies call it BlahBlah Rating, but is nothing more than market segmentation to accrue consumers' surplus. Not what Adam Smith (the real one) had in mind.
The combination of no tax credits and an ineffective coverage requirement could well push a State's individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner.