WEDNESDAY, March 28 (HealthDay News) -- Striking down the
so-called "individual mandate," the most controversial provision of
the Affordable Care Act, should the Supreme Court do so, wouldn't
deliver a death blow to the health-reform package. But, it would
alter projected costs and consumer participation, health policy
"If the individual responsibility provision is struck down, it is important that mechanisms are in place to ensure there's a balance in insurance pools to make sure younger, healthier people participate so premiums don't escalate," said Ron Pollack, executive director of Families USA, a national advocacy group for health-care consumers.
Pollack, who supports the Affordable Care Act, said other
methods of attaining broad participation exist to hold down
insurance costs, but it's premature to discuss them. The individual
mandate -- which imposes penalties on those who don't buy insurance
-- is the most effective formula, he said.
"Massachusetts has the individual insurance provision, and the experience in Massachusetts shows it does work," Pollack said.
It's estimated that at least 30 million uninsured Americans
would gain health insurance under the law, 16 million as a result
of the individual mandate.
Pollack said that even without the individual mandate, the
health-care legislation includes other provisions for extending
coverage to millions of people currently without insurance.
For instance, Medicaid eligibility will expand to include
citizens and legal residents with annual incomes up to 133 percent
of the federal poverty level -- about $14,850 for a single adult
and $30,650 for a family of four in 2012. And federal tax subsidies
will enable certain other people to buy coverage, Pollack said.
It's estimated that Medicaid expansion would add 16 million people
to the rolls of the insured.
John Goodman, president of the National Center for Policy
Analysis, which opposes the health-reform law, said he anticipates
affordability problems with or without the individual mandate.
"The mandate itself is pretty weak to begin with," he said. "I think people are overestimating its importance."
While the provision calls for most American adults to obtain
health insurance, people who don't earn enough to file federal
income tax returns and many others are exempt, Goodman pointed out.
"That's millions of people," he said.
Goodman also said the penalties for not buying insurance are
small compared to the price of insurance. That might tempt some
people to "game the system" -- waiting until they're sick to buy
insurance and canceling it when they're well -- "which will make it
very expensive," he said.
Enforcement of the individual mandate will be left to the
Internal Revenue Service, Goodman said, adding he doubts the agency
will pursue violators aggressively. Fines will be phased in until
2016, when individuals refusing to obtain insurance would pay $695
and families $2,085 or 2.5 percent of total taxable income,
according to figures from the Henry J. Kaiser Family
For many people, that's a lot less than the cost of insurance,
Goodman said. Although it varies by region and age, typical
insurance premiums in 2016 are expected to average about $5,800 for
an individual and $15,200 for a family of four, according to
Goodman's analysis of figures from the Congressional Budget
"This whole approach is flawed," Goodman said. He suggested that the architects of the Affordable Care Act should have taken cues from Medicare. "If you look at Medicare Part B premiums and Medicare Part D premiums, provisions and methods are in place to prevent people from gaming the system."
Pollack remains unfazed by that argument. If the penalties
aren't strong enough, he said, "that can be corrected."
The RAND Corporation, a nonprofit research organization,
predicts that the cost of buying policies through new insurance
exchanges would increase only slightly if the individual mandate
provision were removed. (The exchanges will be created to help
small businesses and individuals purchase insurance through a more
organized and competitive market.)
However, because fewer people would buy insurance if the mandate
were eliminated, costs borne by the federal government would rise,
the researchers said.
Eliminating the individual mandate would cut the predicted
number of Americans buying new health coverage in 2016 from 27
million to 15 million and increase an individual's cost of buying
insurance by 2.4 percent, according to the RAND analysis.
But Christine Eibner, an economist at RAND, said government
spending for each person newly enrolled in a health insurance plan
would more than double, reaching nearly $7,500 a person.
"Without the individual mandate, the government would have to spend more overall to insure a lot fewer people," Eibner said in a RAND news release.
The U.S. Department of Health and Human Services outlines how
women will fare under the
Affordable Care Act.
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