NFT: If Congress eliminates the health insurance mandate

subject to a fine

I believe eliminating the mandate just means that you won't have a tax penalty if you don't enroll in health insurance.

But to answer your questions, I think everything stays the same, logistically, except that it's no longer mandatory to sign up.

No fine for not signing up.

Without other changes, it will raise premiums for those who choose to have health insurance. The purpose of the mandate is to keep down premiums because you will require people to pay premiums who won't use any benefits. Remove that and the premiums will have to rise elsewhere because those people who now have insurance who use more in benefits than they pay in premiums are not going to drop their insurance voluntarily.

Because there will be few healthy people in the pool.

Says

mandate also usually are the ones who receive subsidies. This will save the government money they would have normally spent on those subsidies. That money can then be redirected to tax cuts and still stay under the rule of "don't raise the debt by more than 1.5 trillion over 10 years". Those folks who are declining insurance would also reduce the insurance pool, which increases premiums for the rest.

needs a stick to get healthy people into the insurance pool. The individual mandate isn't a big stick, but it's something. Otherwise the whole concept of insurance stops making much sense. You need to have a whole lot of people paying in and not taking much out to keep make the whole system affordable for people who actually need stuff covered, whether it's for accidents or major illness or chronic illness.

So without the individual mandate:
A lot of people who are currently insured but would rather just take their chances drop their plans.
Premiums probably go way, way up.
Coverage is trimmed back.
A lot of people who are currently insured are priced out of the market, and are basically left to fend for themselves.

And then the debate shifts toward single-payer, because the alternative was tried and it wasn't politically sustainable.

is how does that reduce the deficit(how does eliminating the fine reduce the deficit), but after googling it. It appears to cut the subsidies on the exchanges, also, so people on the exchanges will have to pay more. Of cause what this will do is that there will be people that don't want to pay for insurance so when they get sick or hurt, it will be people that are responsible that will be paying for it.

Having to pay $600 to me isn't commissioning people to do it....which is the whole idea behind the ACA. Get an entire population of people into the pool.

Like with car insurance. You aren't driving without it...there's no way to "opt out".

I'm guessing that any insurance play cost more than $600 per year, so certain young people or other group may have rolled the dice and paid the $600 penalty.

Thanks everyone so far for not being crazy.

In comment 13693135 Fred in Atlanta said:

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is how does that reduce the deficit(how does eliminating the fine reduce the deficit), but after googling it. It appears to cut the subsidies on the exchanges, also, so people on the exchanges will have to pay more. Of cause what this will do is that there will be people that don't want to pay for insurance so when they get sick or hurt, it will be people that are responsible that will be paying for it.

It reduces the deficit b/c CBO projects that fewer people will sign up for the exchanges, thereby lowering the amount of subsidies paid by the government. It doesn't cut the subsidy level, it affects the number of people who would enroll in the exchanges.

As to the other question, eliminating the mandate doesn't eliminate the exchanges, it just means people don't pay a tax if they don't have insurance.

Will keep it, especially if they get subsides. You know, having health insurance is not such a bad thing.

The insurance companies make their money from all the twenty somethings who are forced to get coverage. Get rid of the mandate and a lot of young people will risk going without insurance. That will jack rates even higher for everyone else.

The mandate was the plum that was dangled in front of the insurance industry to get them on board with the Affordable Care Act. Get rid of that and the whole thing will go down the tubes.

Not taking a position on whether that is good or bad. Just pointing out what the real strategy is.

will still show up in the ER and add to health care costs in a more expensive and less efficient problem.

If electing out of insurance is an individual right, and then you draw on public welfare for health care, you should be fined, Like being fined for driving without insurance when you get in a car accident.

In comment 13693152 RobCarpenter said:

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As to the other question, eliminating the mandate doesn't eliminate the exchanges, it just means people don't pay a tax if they don't have insurance.

Yes, though the exchanges might functionally cease to exist. With fewer healthy people in the pool, whatever insurers remain in the exchange may jack prices up to a level that no one can afford. Or all insurers might leave some markets altogether, leaving no individual insurance option.

In comment 13693162 WideRight said:

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will still show up in the ER and add to health care costs in a more expensive and less efficient problem. If electing out of insurance is an individual right, and then you draw on public welfare for health care, you should be fined, Like being fined for driving without insurance when you get in a car accident.

Even if fined, who to say they will pay the fine?

In comment 13693120 BobOnLI said:

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Because there will be few healthy people in the pool.

Speaking of skyrocket, remember when we used to skyrocket dudes into orbit & the moon with just our laying around money? Just extra tax dollars sitting there and we would skyrocket shit into orbit. That was pretty cool.

Will insurers begin to offer plans that would not be currently ACA compliant? Catastrophic plans that would give a target market, perhaps males between 28 and 45 who don't get employer based insurance and have something (assets) to lose if they have an unexpected major problem. A huge deductible, say $10,000., but they get the benefits of the insurance plans rate schedule. Face it, for anyone who's not broke the rates charged by hospitals to those without coverage is more of an incentive to get insurance than any fine currently in place under the ACA.

BTW, didn't Vermont try single payer only to drop is rather quickly because the results were not pretty?

In comment 13693169 Fred in Atlanta said:

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In comment 13693162 WideRight said: Quote: will still show up in the ER and add to health care costs in a more expensive and less efficient problem. If electing out of insurance is an individual right, and then you draw on public welfare for health care, you should be fined, Like being fined for driving without insurance when you get in a car accident. Even if fined, who to say they will pay the fine?

IRS

In comment 13693201 njm said:

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Will insurers begin to offer plans that would not be currently ACA compliant? Catastrophic plans that would give a target market, perhaps males between 28 and 45 who don't get employer based insurance and have something (assets) to lose if they have an unexpected major problem. A huge deductible, say $10,000., but they get the benefits of the insurance plans rate schedule. Face it, for anyone who's not broke the rates charged by hospitals to those without coverage is more of an incentive to get insurance than any fine currently in place under the ACA. BTW, didn't Vermont try single payer only to drop is rather quickly because the results were not pretty?

Well, they didn't repeal ACA, so the minimal plans probably would still be disallowed.

VT couldn't get single payer off the ground. It was hard to do. The feds could do it pretty easily.

and eliminate all preferential tax treatment for employer provided insurance.

Everyone buys their plan directly with pre-tax income, businesses (especially smaller businesses) are unburdened from massive premiums - often bolstering salaries as a result - individuals have freedom of movement without "job lock", and the risk pools per state become exponentially larger, dropping costs.

Companies flush with cash (big tech, etc) will likely still offer health plans, or perhaps supplemental Cadillac level benefits, but they'll have to do so on an even playing field tax-wise with those buying their own.

The exchanges will cease to be the red headed stepchild of the insurance market(s) as they become the marquee event. Watch how fast they work (relatively speaking...this is the insurance industry, after all) then.

The mandate is a key component. If one doesn't understand why after 8 years of this debate (it should have been obvious even before then), it will be difficult to explain.

This approach would require true bipartisan leadership so it won't happen but it's vastly superior to the current system, the sociopathic previous one, or pie in the sky and flawed in its own right Single Payer.

In comment 13693203 Heisenberg said:

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Well, they didn't repeal ACA, so the minimal plans probably would still be disallowed.

I don't know the ACA chapter and verse but are you sure? Did they not offer noncompliant plans because the law prohibited it, or because they wouldn't sell plans that automatically triggered a fine and the exposure that would create?

In comment 13693221 njm said:

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In comment 13693203 Heisenberg said: Quote: Well, they didn't repeal ACA, so the minimal plans probably would still be disallowed. I don't know the ACA chapter and verse but are you sure? Did they not offer noncompliant plans because the law prohibited it, or because they wouldn't sell plans that automatically triggered a fine and the exposure that would create?

Non-compliant plans are prohibited by the law. Insurers can’t issue them.

Enrollment in ACA is up.

Maybe all the coverage it's gotten makes people realize, hey, it's important to have health insurance!!!!!

In comment 13693226 Jim in Fairfax said:

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In comment 13693221 njm said: Quote: In comment 13693203 Heisenberg said: Quote: Well, they didn't repeal ACA, so the minimal plans probably would still be disallowed. I don't know the ACA chapter and verse but are you sure? Did they not offer noncompliant plans because the law prohibited it, or because they wouldn't sell plans that automatically triggered a fine and the exposure that would create? Non-compliant plans are prohibited by the law. Insurers can’t issue them.

Thanks. If they repeal the mandate these plans make a lot of sense and it wouldn't affect the deficit so it could be included. But I doubt anyone down there is thinking about such things.

In comment 13693240 njm said:

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Thanks. If they repeal the mandate these plans make a lot of sense and it wouldn't affect the deficit so it could be included. But I doubt anyone down there is thinking about such things.

Allowing non-compliant plans would mean reapealing the entire ACA.

In comment 13693246 Jim in Fairfax said:

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In comment 13693240 njm said: Quote: Thanks. If they repeal the mandate these plans make a lot of sense and it wouldn't affect the deficit so it could be included. But I doubt anyone down there is thinking about such things. Allowing non-compliant plans would mean reapealing the entire ACA.

OK. Another result of Justice Roberts defining the penalty as a tax. Who knew?

In comment 13693162 WideRight said:

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will still show up in the ER and add to health care costs in a more expensive and less efficient problem. If electing out of insurance is an individual right, and then you draw on public welfare for health care, you should be fined, Like being fined for driving without insurance when you get in a car accident.

Agreed. I remember arguments on the 'right' to smoke. Fine -- help pay the economic health/social/ productivity costs of your freedom.

In comment 13693135 Fred in Atlanta said:

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is how does that reduce the deficit(how does eliminating the fine reduce the deficit), but after googling it. It appears to cut the subsidies on the exchanges, also, so people on the exchanges will have to pay more. Of cause what this will do is that there will be people that don't want to pay for insurance so when they get sick or hurt, it will be people that are responsible that will be paying for it.

As said above: Fewer people insured, less paid out in subsidies.

So the proposition is a big tax cut for a small slice of people and some business plus a small tax cut for a lot of people, in exchange for big health insurance premium increases, lots of people losing coverage altogether and lots of other people losing coverage for pre-existing conditions.

The justification for that is that the big tax cuts for high earners and businesses are going to trickle down, cause the tide to rise and lift all boats, so to speak, and in the end more people will be able to afford insurance, and better insurance.

In comment 13693120 BobOnLI said:

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Because there will be few healthy people in the pool.

you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance.

BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?

In comment 13693264 81_Great_Dane said:

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In comment 13693135 Fred in Atlanta said: Quote: is how does that reduce the deficit(how does eliminating the fine reduce the deficit), but after googling it. It appears to cut the subsidies on the exchanges, also, so people on the exchanges will have to pay more. Of cause what this will do is that there will be people that don't want to pay for insurance so when they get sick or hurt, it will be people that are responsible that will be paying for it. As said above: Fewer people insured, less paid out in subsidies. So the proposition is a big tax cut for a small slice of people and some business plus a small tax cut for a lot of people, in exchange for big health insurance premium increases, lots of people losing coverage altogether and lots of other people losing coverage for pre-existing conditions. The justification for that is that the big tax cuts for high earners and businesses are going to trickle down, cause the tide to rise and lift all boats, so to speak, and in the end more people will be able to afford insurance, and better insurance.

If plans have to remain ACA compliant nobody will lose coverage for preexisting conditions.

In comment 13693292 EricJ said:

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In comment 13693120 BobOnLI said: Quote: Because there will be few healthy people in the pool. you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance. BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?

Well, that's the thing....are you really being forced, as in a mandate? Not really....you can opt out.

To me a mandate would be something like you don't sign up, you can't go to a doctor or the ER (okay, obviously that's exaggerated).

But look at in these terms, to drive you are forced to buy car insurance.......you may not want it (to pay for it) or ever need it (no car insurance) but it's against the law to drive and not have it.

In comment 13693130 81_Great_Dane said:

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needs a stick to get healthy people into the insurance pool. The individual mandate isn't a big stick, but it's something. Otherwise the whole concept of insurance stops making much sense. You need to have a whole lot of people paying in and not taking much out to keep make the whole system affordable for people who actually need stuff covered, whether it's for accidents or major illness or chronic illness. So without the individual mandate: A lot of people who are currently insured but would rather just take their chances drop their plans. Premiums probably go way, way up. Coverage is trimmed back. A lot of people who are currently insured are priced out of the market, and are basically left to fend for themselves. And then the debate shifts toward single-payer, because the alternative was tried and it wasn't politically sustainable.

If you haven’t noticed, premiums have been going way up, even with the mandate. The mandate was never a good idea. On one hand, you have insurance companies charging exorbitant rates because they have a captive client base (like going to a ballpark, and finding you have to pay $9 for a beer and $8 for a hotdog; you know these things should be cheaper, but where else are you going to go). On the other hand, you have a lot of young healthy individuals paying a lot of money into a healthcare system from which most receive little if any benefit. They wanted a single payer system, but knew the voters didn’t; so, I guess the mandate was viewed as the next best thing.

fIn comment 13693160 Vanzetti said:

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The insurance companies make their money from all the twenty somethings who are forced to get coverage. Get rid of the mandate and a lot of young people will risk going without insurance. That will jack rates even higher for everyone else. The mandate was the plum that was dangled in front of the insurance industry to get them on board with the Affordable Care Act. Get rid of that and the whole thing will go down the tubes. Not taking a position on whether that is good or bad. Just pointing out what the real strategy is.

It was already going down the shitter. Insurance companies have been pulling out of the exchanges for the last two years.

In comment 13693292 EricJ said:

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In comment 13693120 BobOnLI said: Quote: Because there will be few healthy people in the pool. you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance. BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?

who doesn't need healthcare? If someone is uninsured and doesn't pay their hospital bills guess who ends up paying them?

In comment 13693130 81_Great_Dane said:

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needs a stick to get healthy people into the insurance pool. The individual mandate isn't a big stick, but it's something. Otherwise the whole concept of insurance stops making much sense. You need to have a whole lot of people paying in and not taking much out to keep make the whole system affordable for people who actually need stuff covered, whether it's for accidents or major illness or chronic illness. So without the individual mandate: A lot of people who are currently insured but would rather just take their chances drop their plans. Premiums probably go way, way up. Coverage is trimmed back. A lot of people who are currently insured are priced out of the market, and are basically left to fend for themselves. And then the debate shifts toward single-payer, because the alternative was tried and it wasn't politically sustainable.

Generally speaking, the practicality of single payer is hard to deny.

In comment 13693327 GentleGiant said:

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In comment 13693292 EricJ said: Quote: In comment 13693120 BobOnLI said: Quote: Because there will be few healthy people in the pool. you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance. BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need? who doesn't need healthcare? If someone is uninsured and doesn't pay their hospital bills guess who ends up paying them?

Imagine how many people would sign up if they weren't able to go to the hospital without insurance??

In comment 13693292 EricJ said:

Quote:

In comment 13693120 BobOnLI said: Quote: Because there will be few healthy people in the pool. you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance. BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?

Nope, I don't like it either. I think the bigger issue with the ACA, is that it did nothing to address the rising cost of healthcare and to make it more affordable. Sure, it includes tax payer subsidies to some, but that’s robbing Peter to pay Paul and just throwing money at a problem without trying to fix it. There were a lot of things that could have been done and should have been looked at to bring the costs down, but weren’t:
- Allowing individuals to buy insurance across state lines
- Tort reform
- Legislation that prevents drug manufactures from charging US citizens 54% more for drugs than what they charge the rest of the world for the same
- Etc…..

In comment 13693254 njm said:

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In comment 13693246 Jim in Fairfax said: Quote: In comment 13693240 njm said: Quote: Thanks. If they repeal the mandate these plans make a lot of sense and it wouldn't affect the deficit so it could be included. But I doubt anyone down there is thinking about such things. Allowing non-compliant plans would mean reapealing the entire ACA. OK. Another result of Justice Roberts defining the penalty as a tax. Who knew?

I'm guessing someone has some compromising videos of Judge Roberts (;>

In comment 13693203 Heisenberg said:

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In comment 13693201 njm said: Quote: Will insurers begin to offer plans that would not be currently ACA compliant? Catastrophic plans that would give a target market, perhaps males between 28 and 45 who don't get employer based insurance and have something (assets) to lose if they have an unexpected major problem. A huge deductible, say $10,000., but they get the benefits of the insurance plans rate schedule. Face it, for anyone who's not broke the rates charged by hospitals to those without coverage is more of an incentive to get insurance than any fine currently in place under the ACA. BTW, didn't Vermont try single payer only to drop is rather quickly because the results were not pretty? Well, they didn't repeal ACA, so the minimal plans probably would still be disallowed. VT couldn't get single payer off the ground. It was hard to do. The feds could do it pretty easily.

Not really. They have tried to do that with the VA, and we know what a mess that has been.

In comment 13693297 njm said:

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If plans have to remain ACA compliant nobody will lose coverage for preexisting conditions.

Insurance companies will be required to cover people regardless of pre-existing conditions, and the mandate will be removed?

In comment 13693361 schabadoo said:

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In comment 13693297 njm said: Quote: If plans have to remain ACA compliant nobody will lose coverage for preexisting conditions. Insurance companies will be required to cover people regardless of pre-existing conditions, and the mandate will be removed?

For people that buy their policies, yes. Read the whole discussion including what Jim in Fairfax wrote.

In comment 13693201 njm said:

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Will insurers begin to offer plans that would not be currently ACA compliant? Catastrophic plans that would give a target market, perhaps males between 28 and 45 who don't get employer based insurance and have something (assets) to lose if they have an unexpected major problem. A huge deductible, say $10,000., but they get the benefits of the insurance plans rate schedule. Face it, for anyone who's not broke the rates charged by hospitals to those without coverage is more of an incentive to get insurance than any fine currently in place under the ACA. BTW, didn't Vermont try single payer only to drop is rather quickly because the results were not pretty?

The kind of plans you're talking about were heavily featured in "The Rainmaker."

he can explain it.

Boy have we lost a lot of good posters.

In comment 13693352 Beer Man said:

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In comment 13693292 EricJ said: Quote: In comment 13693120 BobOnLI said: Quote: Because there will be few healthy people in the pool. you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance. BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need? Nope, I don't like it either. I think the bigger issue with the ACA, is that it did nothing to address the rising cost of healthcare and to make it more affordable. Sure, it includes tax payer subsidies to some, but that’s robbing Peter to pay Paul and just throwing money at a problem without trying to fix it. There were a lot of things that could have been done and should have been looked at to bring the costs down, but weren’t: - Allowing individuals to buy insurance across state lines - Tort reform - Legislation that prevents drug manufactures from charging US citizens 54% more for drugs than what they charge the rest of the world for the same - Etc…..

The usual shibboleths.

In comment 13693364 njm said:

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In comment 13693361 schabadoo said: Quote: In comment 13693297 njm said: Quote: If plans have to remain ACA compliant nobody will lose coverage for preexisting conditions. Insurance companies will be required to cover people regardless of pre-existing conditions, and the mandate will be removed? For people that buy their policies, yes. Read the whole discussion including what Jim in Fairfax wrote.

Thanks, I see it.

That's what I was thinking, just untenable under those circumstances.

take his posts with a grain of salt.

A) the relative judiciousness of "sell across state lines" has been exposed time and time again and it's largely cited by those unable or unwilling to grasp the intricacies wedded to something as complicated as our system of insurance.

It could theoretically work with extremely stringent federal guidlines, but we know that is despised by a powerful group. As it stands, it is guaranteed to be a race to the bottom as states deregulate companies like crazy to milk local economic benefits. Like what happened with credit card companies leading to, among other things, usurious rates.

B) The VA is not single payer. The latter uses private providers - the gov't foots the bill. The VA is owned and run by Uncle Sam and most providers are gov't employees. (It's also unbelievably overwhelmed, but that's another discussion).

I am not a single payer advocate, but it's useful for the non-lazy among us to get their facts straight lest they diminish the conversation with red herrings & erroneous information.

In comment 13693292 EricJ said:

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BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?

Like car insurance and homeowner's insurance?