Mandate math

RAND Corp. recently released one more estimate of health insurance coverage and costs with and without the health reform law mandate that (pretty much) everyone must be insured. About 12.5 million fewer people would be covered minus the requirement, which is being challenged in a case before the U.S. Supreme Court. Those that would be covered would be those eligible for hefty subsidies, RAND said, leaving the federal government tab unchanged despite millions fewer insured.

Should the Supreme Court reject the individual mandate, but uphold the rest of the law, RAND projected 14.6 million (PDF) would gain benefits as of 2016, or 87% of the non-elderly population. That's compared with 27.1 million newly insured should the mandate remain intact, or 91% of the non-elderly population. Among households with income between 250% and 400% of the federal poverty threshold, 80% would be insured without the mandate compared with 86% if insurance were legally required.

“These results suggest that people with modest incomes that are nevertheless too high to qualify for Medicaid or substantial subsidies will be the individuals most likely to remain uninsured if the individual mandate is eliminated,” wrote authors Christine Eibner and Carter Price in a new RAND report.

New federal spending for each newly insured individual would increase to $7,468 in 2016 without the insurance mandate, compared with $3,659 with the law, the report said.

Premiums for the individual market—where the lack of a mandate would result in the most significant change in coverage—would increase by 9.3%, on average. However, once authors adjusted the estimate for changes in the age composition of the insured, premiums increased 2.4% minus an insurance requirement.

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