How Much Does the Mandate Matter, Anyway?


| 6/22/2012 3:52:57 PM


Tags: Affordable Care Act, Individual Mandate, Barack Obama, Health Care Reform, Supreme Court, Anthony Kennedy, Medicaid, Sam Ross-Brown.,

Supreme Court Cartoon

A lot of Americans have been bracing for bad news from the Supreme Court this week. No one knows how the Court will decide on the Affordable Care Act (ACA), but it doesn’t look good for the law’s supporters. In particular, Anthony Kennedy’s tough questions for Obama’s solicitor general during last March's hearings don’t bode well. If Kennedy turns out to be the bench’s swing vote, his dead-set passion for individual liberty may spell big trouble for the law's insurance mandate.

But how important is the mandate? Actually, for most Americans, not that much, says the Nation’s George Zornick. While the mandate does make getting individual insurance mandatory, the vast majority of Americans are either insured already, qualify for assistance, or are exempt. That’s according to a recent Urban Institute study that Zornick cites, which puts the ongoing debate into a little bit of context. For starters, about a third of nonelderly Americans (88m) don’t have to worry about the mandate at all. The list of official exemptions is a long one, and includes Native Americans, those with religious objections, the very poor, prisoners, and others. And most of these people (63m) already have some kind of insurance anyway.

And if you’re not exempt, chances are you already have insurance, or you qualify for assistance. According to the Urban Institute, 26 million now-uninsured Americans would need to buy into a plan, but most (19m) would qualify for free coverage through Medicaid or CHIP, or receive subsidies for private plans. It’s the remaining 7 million that much of the controversy is about. And because eligibility for Medicaid and other assistance is mostly based on income, there’s much less of a chance that the mandate would punish the people who can’t afford coverage in the first place.   

All told, if the entire ACA went into effect today, about 98 percent of Americans would comply with the mandate, or qualify for assistance. That means that the number of Americans who oppose the ACA (47 percent) is more than 20 times the number who would personally be affected by the mandate. As long as the safety-net parts of the ACA remain intact, most people probably wouldn’t notice if we lost the mandate.    

So who should really be biting their nails right now? Insurance companies, says Kevin Drum. Writing on MotherJones.com, Drum points out that the mandate is really set up to benefit them. This was the Obamacare argument all along: without a mandate, healthy people won’t buy in. Insurers would then have to pick up the tab for millions of Americans who until now couldn’t get coverage because they were too sick—not to mention the healthy people once they finally get sick themselves.

Jim Palmer
6/27/2012 8:41:32 PM

I am not getting this to jive with the Utne Reader article on "Minimum Rage: College Grads in the Service Industry." It says that "Nearly half of people ages 16 to 29 do not have a job. A quarter of those who do work in hospitality—travel, leisure, and, of course, food service." These are mostly very low wage jobs without health insurance, and there is no current Medicaid support for these people. In addition growing numbers of these people are college graduates with debt because we do not really have public education in this country. Not only are they poor, but they have unreasonable debt that will help keep them that way for a long time. They go in and out of employment, so they either never have healthcare or it is undependable.The statistics of the UI report may add up, but something about it does not pace the face test of my experience with this age group.