Individual Mandate Policy Patient Protection and Affordable

Individual Mandate

Policy

Patient Protection and Affordable Care Act of 2010:

Individual mandate

Supreme Court's recent upholding of the individual mandate of the Patient Protection and Affordable Care Act of 2010 was deemed to be an essential component of the enforcement of the Act. The individual mandate, and the ACA overall was designed to address the systemic problems within the American healthcare system related to the high costs of care and the lack of coverage for many Americans. 50 million Americans currently lack health insurance. "Before the legislation is fully phased in, Americans can be charged higher premiums when they are sick, and adults can be denied coverage because of a pre-existing condition... Illness or medical bills cause 62% of all personal bankruptcies (Tandem & Spiro 2012: 1). Without the individual mandate, the other provisions of the Act would have been unenforceable, even if provisions such as the prohibition of discriminating against patients with preexisting conditions had been upheld. The individual mandate requires all Americans who can afford to do so to purchase some form of health insurance, with a "minimally comprehensive policy" if they are not covered by private or government-provided insurance (such as Medicaid, the federal and state-run program for the indigent and Medicare, the federal insurance program for the elderly) (Klein 2010).

The provision 'afford to do so' is one of the most-overlooked aspects of the law. "For the purposes of the law, 'individuals who can afford health-care insurance' is defined as people for whom the minimum policy will not cost more than 8% of their monthly income, and who make more than the poverty line. So if coverage would cost more than 8% of your monthly income, or you're making very little, you're not on the hook to buy insurance (and, because of other provisions in the law, you're getting subsidies that make insurance virtually costless anyway)" (Klein 2010). The hysteria that ensued amongst some right-wing pundits that the mandate would bankrupt poorer working Americans thus has little foundation. Ironically, despite the great amount of heat generated about the mandate, the majority of Americans will not even notice its implementation into law. The majority of Americans have health insurance provided through their employer. For Americans who do not and who do not qualify for government programs, they must purchase their health insurance on the open market.

If Americans without health insurance refuse to do so and their income is above the specified terms of the law, they must pay a fine. "In 2016, the first year the fine is fully in place, it will be $695 a year or 2.5% of income, whichever is higher. That makes the mandate progressive" (Klein 2010). The intention of the fine is to make it more costly for individuals not to have insurance on a monthly basis, so they will purchase healthcare for themselves and not put themselves at constant personal and financial risk, not getting regular healthcare and relying upon emergency rooms when seriously injured.

The purpose of the mandate is to enable another provision of the Act, the prohibition against discriminating against persons with preexisting conditions, from taking effect. "Now that insurers can't discriminate based on preexisting conditions, it would be entirely possible for people to forgo insurance until, well, they develop a medical condition. In that world, the bulk of the people buying insurance on the exchanges are sick, and that makes the average premiums terrifically expensive. The mandate is there to bring healthy people into the pool, which keeps average costs down and also ensures that people aren't riding free on the system by letting society pay when they get hit by a bus" (Klein 2010). Without the requirement that everyone possess insurance, fewer healthy people would buy insurance, persons with coverage would be sicker on average, and "this 'adverse selection' would drive up premiums, which in turn would cause even more healthy individuals to drop coverage -- possibly leading to a so-called 'death spiral'" (Tanden & Spiro 2012: 3).

The individual mandate is thus designed to make the healthcare system fairer even for persons who are currently covered under employer-provided insurance. The costs to them because of the systemic inequalities in the system are considerable as well -- for example, uninsured Americans received care in excess of 57.4 billion in 2008, resulting in the need for health insurers to raise premiums to cover the cost (Tanden & Spiro 2012:1). At present, healthcare costs today account for 17% of the U.S. GDP and "the average family pays an additional $1,000 annually in the form of higher premiums to subsidize the costs incurred by those who receive care but do not carry insurance. The mandate is an indispensable tool for achieving the government's compelling goals of universal coverage and lower costs" (Why the individual mandate matters so much, 2012, The Washington Post).

Another attempt to expand the risk pool includes the provision that young adults up to the age of twenty-six are allowed to remain on their parents' health insurance, which infuses the 'risk pool' with healthier, younger individuals. "This reform has already had a significant impact, covering an additional 2.5 million young adults. In 2014, more than 90% of young people enrolling through exchanges will be eligible for premium tax credits. In addition, young adults under the age of 30 will be able to enroll in a low-cost catastrophic plan" (Tanden & Spiro 2012:11). Because of the recent recession, many young people who would have ordinarily found work with employer-provided insurance have not; allowing them to remain on their parent's healthcare plan has become one of the most popular components of the Affordable Care Act, but without the provisions of the individual mandate it too would likely be impossible to sustain.

However, the provisions of enforcement of the penalty, once the individual mandate takes effect are unclear. "And what happens if you don't buy insurance and you don't pay the penalty? Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don't pay the fine. If this actually leads to a world in which large numbers of people don't buy insurance and tell the IRS to stuff it, you could see that change. But for now, the penalties are low and the enforcement is non-existent" (Klein 2010).