The individual mandate: Can it survive the election?

A major goal of the Affordable Care Act is to lower the uninsured rate by expanding coverage options and reducing costs. Both the employer mandate and the individual mandate are intended to ensure that carriers have enough healthy members to offset the cost of older, sicker people in their plans.

Both mandates are enforced with a play-or-pay approach. While employers are balking at the paperwork, they’re generally playing along, although the true test will come in 2020 when the excise tax goes into effect.

But individuals are a different story. Many say that paying the penalty of $695 per adult or 2.5% of household income is more affordable than purchasing coverage. In particular, young, healthy adults are spurning coverage altogether, according to Forbes. And last fall, the Kaiser Family Foundation reported that half of the uninsured who were eligible for subsidized coverage refused to purchase it.

The result? Both large and small insurers are losing money on certain exchange plans at an unsustainable rate. And they’re taking the logical step of withdrawing from counties where their losses are the significant, or they’re limiting their offerings to plans that are financially sustainable.

So what’s next?

With an election just around the corner, all things health care — including the individual mandate — are up for debate and options are being explored.

If Hillary Clinton becomes president, expect the mandate to continue in some form. Given her history of support for health reform, she could even find new ways to work with Republicans to fix the most broken parts of the bill, according to Bloomberg News.

Presidential candidate Donald Trump has been very clear on his stance. If he keeps his pledge, the mandate will go the way of the dinosaur because his administration will ask Congress for a repeal of the Affordable Care Act on the first day he’s in office.

Other Republicans are considering less dramatic approaches to weaken the mandate.

  • In early September, a new bill was introduced that would exempt people from the individual mandate if they live in a county with one or no options for coverage. The bill, which was introduced by Sen. John McCain (R-Arizona) and co-sponsor Sen. Ron Johnson (R-Wisconsin), could impact nearly one-third of counties in 2017 based on information from the Kaiser Family Foundation.
  • The “World’s Greatest Healthcare Plan Act of 2016” is new legislation introduced by Pete Sessions, a Texas Republican who runs the influential House Rules Committee, and Senator Bill Cassidy (R-Louisiana). This would eliminate both the individual mandate and the employer mandate.
  • Then there’s the “Obamacare Tax Relief and Consumer Choice Act of 2016,” introduced by Senators Tom Cotton (R-Arkansas), Kelly Ayotte (R-New Hampshire), John McCain (R-Arizona), James Lankford (R- Oklahoma), Ron Johnson (R- Wisconsin), and Richard Burr (R- North Carolina). This would suspend the individual mandate when health insurance premiums rise, thus “providing relief to people who can’t afford Obamacare deductibles.”

There’s an old saying, “The only constant is change.” It’s as true today as it was in 500 B.C. when Heraclitus first introduced it.

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