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Mandatory reading: Study says reform falls short without compulsory enrollment

By Jessica Zigmond
11:30 am, Jan. 16

In two months, the U.S. Supreme Court will begin hearing oral arguments to determine the constitutionality of the Patient Protection and Affordable Care Act, with two hours devoted to the law's individual mandate. Now comes a new report funded by the Robert Wood Johnson Foundation—and prepared by researchers at the left-leaning Urban Institute—that shows what could happen if the individual mandate is eliminated.

The findings show that while the health reform law would decrease the number of non-elderly uninsured by about half to 26 million people, the individual mandate (the federal requirement that Americans be covered by health insurance or else pay a penalty) is essential to making that happen. Without it, the researchers conclude, 40 million to 42 million people would remain uninsured. Meanwhile, the report shows that while the Affordable Care Act is expected to increase private insurance coverage by about 7 million people, without a mandate, private coverage would fall by about 11 million—therefore covering 4 million fewer people than would have been covered otherwise.

“We analyzed the relationship between exchange enrollment and premiums,” the report continued, “simulating the ACA with the mandate, and several alternative scenarios without it, representing different levels of exchange enrollment. Without a mandate, non-group premiums overall would increase by roughly 10% with high exchange participation and by 25% with low participation.”

According to the report, the analysis has been updated from a similar one a year ago to reflect recent survey data and the latest federal draft regulations and current trends in state implementation decisions. Take a look at the full analysis and its methods (PDF).

Follow Jessica Zigmond on Twitter @MHJZimgond.


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