State-level insurance mandates could save Obamacare
Lawmakers in several states are considering individual insurance mandates to replace the federal mandate. What if other states follow?
In response to the Republican efforts in Washington D.C. to undermine the Affordable Care Act, Democratic-run state governments are considering measures to protect the gains that their states have experienced as a result of the landmark health law.
Notably, lawmakers in Hawaii, Maryland, Connecticut and Washington state are considering putting in place individual insurance mandates to replace the federal mandate that was eliminated in tax legislation that President Trump signed in December.
Related: Repeal of ACA employer mandate inches closer
Intrigued by the idea, the Commonwealth Fund analyzed what would happen if every state put in place an insurance mandate.
In such a parallel universe existed, “the number of uninsured would be lower by 3.9 million in 2019 and 7.5 million in 2022,” the study concludes. “On average, marketplace premiums would be 11.8 percent lower in 2019. State mandate penalty revenues would amount to $7.4 billion and demand for uncompensated care would be $11.4 billion lower.”
The great majority of the newly insured would sign up for private health plans through the ACA marketplace, but a significant number (660,000) would get their insurance through Medicaid or the Children’s Health Insurance Program. The percentage of Americans covered by either of those programs would increase from 25.1 percent to 25.4 percent.
Nationally, the insured rate would climb from 87.6 percent to 89 percent.
The greatest change would come for higher-income individuals who are not eligible for ACA tax credits. Currently, 2.2 percent of Americans buy unsubsidized health plans through the ACA marketplace. With state mandates in place, that figure would rise to 2.8 percent.
More people who are eligible for ACA tax credits would buy individual plans as well, increasing from 2.9 percent to 3.3 percent of the population.
The study also projects that mandates would reduce premiums by getting more healthy people to sign up for insurance. The original ACA mandate was seen as a necessary part of creating an individual insurance market where insurers would not be able to deny service to those with pre-existing conditions. Without the mandate, there are fewer healthy people to subsidize the coverage of those with the most health problems.