ACA Coverage Gains Could Erode Without Individual Mandate

Eliminating the Affordable Care Act's individual mandate penalty is unlikely to destabilize the individual market in California but could roll back coverage gains, according to a study published in the January issue of Health Affairs.

Vicki Fung, Ph.D., from Massachusetts General Hospital in Boston, and colleagues analyzed data from a 2017 survey of Californians who purchased individual-market plans that year either on or off the Marketplace.

The researchers found that 19 percent of respondents reported they would not have purchased insurance if there had been no penalty. They estimated that premiums would increase by 4 to 7 percent without those enrollees in the risk pool. Those with lower income and education, Hispanics, and those who had been uninsured in the previous year were more likely to report they would forgo insurance if there was no penalty. Younger enrollees and those with no chronic conditions were also more likely to say they would not have purchased insurance compared with older enrollees and those with two or more chronic conditions.

"Eliminating the mandate penalty alone is unlikely to destabilize the California individual market but could erode coverage gains, especially among groups whose members have historically been less likely to be insured," the authors write.

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