The story of a small healthcare startup and its fight for survival against the very federal agencies responsible for its launch as part of the ACA.

In the contentious run-up to the passage of the Affordable Care Act, Congress passed a law to make nonprofit health insurance CO-OPs (formally known as Consumer Operated and Oriented Plans) a viable alternative to the public option. The idea was to create new competition in order to lower health insurance premiums and encourage innovation. Nearly two dozen such low-cost CO-OPs were launched in the wake of the ACA's passage; only four are in operation today.

In Death by Regulation, Dr. Peter L. Beilenson tells the story of a group of Maryland-based public health professionals who launched the Evergreen Health Cooperative, only to discover that the ACA law encouraging CO-OPs was a "plastic plant"—a piece of legislation created for optics but never intended to be functional. Over most of its four years of existence, Evergreen succeeded against all odds, prevailing over naysayers, big insurance companies, Congress, and its founders' naïveté. But in an ironic twist, it was bureaucratic hostility from the Centers for Medicare and Medicaid Services—the very Obama administration agency responsible for the CO-OPs—that led to their collective demise.

Beilenson traces the huge impact of seemingly small policy decisions on the work of his team and the people their CO-OP was built to serve. He recounts the excitement and satisfaction of launching such a valuable healthcare company, as well as the damage done to scores of employees and tens of thousands of satisfied healthcare customers when bureaucrats ran amok. The only book about these idealistic Obamacare CO-OPs and the obstacles they all faced, Death by Regulation offers an insider view of health policy and the reality of starting an insurance company from scratch.

Peter L. Beilenson, MD, MPH, is the director of Sacramento County's Department of Health Services. The former CEO and president of the Evergreen Health Cooperative, he served as the health officer of Howard County, Maryland, from 2007 to 2012 and the health commissioner of Baltimore City from 1992 to 2005. He is the coauthor of Tapping into "The Wire": The Real Urban Crisis.