Does the Individual Mandate Affect Insurance Coverage? Evidence from Tax Returns

2021 ◽  
Vol 13 (2) ◽  
pp. 378-407
Author(s):  
Ithai Z. Lurie ◽  
Daniel W. Sacks ◽  
Bradley Heim
Keyword(s):  
Health Insurance ◽  
Regression Discontinuity ◽  
Insurance Coverage ◽  
Extensive Margin ◽  
Tax Returns ◽  
Individual Mandate ◽  
The Individual ◽  
Substantial Heterogeneity ◽  
Insurance Exchanges ◽  
Return Data

We estimate the effect of the ACA’s individual mandate on insurance coverage using regression discontinuity and regression kink designs with tax return data. We have four key results. First, the actual penalty paid per uninsured month is less than half the statutory amount. Second, nonetheless, we find visually clear and statistically signifi-cant responses to both extensive margin exposure to the mandate and to marginal increases in the mandate penalty. Third, we find substantial heterogeneity in who responds; men are especially responsive. Fourth, our estimates imply fairly small quantitative responses to the individual mandate, especially in the Health Insurance Exchanges. (JEL G22, H24, H51, I13, I18)

scholarly journals Health Reform and the Constitutionality of the Individual Mandate

2011 ◽  
Vol 12 (4) ◽  
pp. 236-244 ◽  
Author(s):  
Jeffrey J. Lee ◽  
Deena Kelly ◽  
Matthew D. McHugh
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Critical Issue ◽  
Economic Effects ◽  
Patient Protection ◽  
Individual Mandate ◽  
The Individual

The Patient Protection and Affordable Care Act (ACA) of 2010 is landmark legislation designed to expand access to health care for virtually all legal U.S. residents. A vital but controversial provision of the ACA requires individuals to maintain health insurance coverage or face a tax penalty—the individual mandate. We examine the constitutionality of the individual mandate by analyzing relevant court decisions. A critical issue has been defining the “activities” Congress is authorized to regulate. Some judges determined that the mandate was constitutional because the decision to go without health insurance, that is, to self-insure, is an activity with substantial economic effects within the overall scheme of the ACA. Opponents suggest that Congress overstepped its authority by regulating “inactivity,” that is, compelling people to purchase insurance when they otherwise would not. The U.S. Supreme Court is set to review the issues and the final ruling will shape the effectiveness of health reform.

State-Run Insurance Exchanges in Federal Healthcare Reform: A Case Study in Dysfunctional Federalism

2012 ◽  
Vol 38 (2-3) ◽  
pp. 548-569
Author(s):  
Kyle Thomson
Keyword(s):  
Health Insurance ◽  
Small Business ◽  
Affordable Care Act ◽  
Bargaining Power ◽  
Healthcare Reform ◽  
Patient Protection ◽  
Individual Mandate ◽  
The Individual ◽  
Insurance Exchanges

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law, resulting in the most sweeping reform of the healthcare marketplace and one of the largest expansions in access to healthcare in American history. A key component to both restructuring the healthcare marketplace and improving access are the health insurance exchanges contained in the ACA. Today, individual and small group purchasers have difficulty finding affordable health insurance in the marketplace because they lack the tools to gather information about plans and because they lack the bargaining power to negotiate for affordable rates the way large purchasers can. In conjunction with the individual mandate, the health insurance exchanges aim to solve inefficiencies in the current marketplace by creating a centralized venue to connect insurers with individual and small business purchasers. Thus it both creates a place for insurers to readily find customers, who are now guaranteed to be there because of the individual mandate, and provides a place for customers to shop for insurance.

The Individual Health Insurance Mandate and Veterans Health Coverage

2019 ◽  
pp. 0095327X1987887 ◽  
Author(s):  
Dongjin Oh ◽  
Frances Stokes Berry
Keyword(s):  
Health Insurance ◽  
Safety Net ◽  
Veterans Health ◽  
Health Coverage ◽  
Health Administration ◽  
Social Safety Net ◽  
Individual Mandate ◽  
Insurance Mandate ◽  
The Individual ◽  
Veteran Health Care

In December 2017, Congress repealed the individual insurance mandate penalty. Given the poor health status of veterans, their higher demands for health insurance, and the substantial number of uninsured veterans, the repeal of the individual mandate should have a significant impact on the veterans. This article investigates how the repeal of the individual mandate effective in January 2019 is likely to affect the number of uninsured veterans and their enrollments in Veterans Affairs (VA) insurance. By analyzing 52,692 nonelderly veterans in Florida and California from 2008 to 2017, the findings suggest that the repeal will lead to a considerable increase in the number of uninsured veterans. Veterans who are unemployed, poor, and suffering disabilities are more likely to sign up for the VA insurance than better-off veterans. Thus, one of the important functions of veteran health care is to serve as a social safety net for vulnerable veterans. Thus, the Veterans Health Administration should establish a policy to minimize the expected negative repercussions of the repeal.

scholarly journals The Affordable Care Act’s Coverage Impacts in the Trump Era

2021 ◽  
Vol 58 ◽  
pp. 004695802110429
Author(s):  
Charles Courtemanche ◽  
Ishtiaque Fazlul ◽  
James Marton ◽  
Benjamin Ukert ◽  
Aaron Yelowitz ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Insurance Coverage ◽  
Community Survey ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
Individual Mandate ◽  
Us Presidential Election ◽  
Causal Impact ◽  
The Individual ◽  
Trump Administration

The 2016 US presidential election created uncertainty about the future of the Affordable Care Act (ACA) and led to postponed implementation of certain provisions, reduced funding for outreach, and the removal of the individual mandate tax penalty. In this article, we estimate how the causal impact of the ACA on insurance coverage changed during 2017 through 2019, the first 3 years of the Trump administration, compared to 2016. Data come from the 2011–2019 waves of the American Community Survey (ACS), with the sample restricted to non-elderly adults. Our model leverages variation in treatment intensity from state Medicaid expansion decisions and pre-ACA uninsured rates. We find that the coverage gains from the components of the law that took effect nationally—such as the individual mandate and regulations and subsidies in the private non-group market—fell from 5 percentage points in 2016 to 3.6 percentage points in 2019. In contrast, the coverage gains from the Medicaid expansion increased in 2017 (7.0 percentage points) before returning to the 2016 level of coverage gains in 2019 (5.9 percentage points). The net effect of the ACA in expansion states is a combination of these trends, with coverage gains falling from 10.8 percentage points in 2016 to 9.6 percentage points in 2019.

scholarly journals Young Adult's Perspectives on Being Uninsured and Implications for Health Reform

2014 ◽  
Author(s):  
Kim Dauner ◽  
Jack Thompson
Keyword(s):  
Young Adults ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
State Health ◽  
Individual Level ◽  
State Health Insurance ◽  
Federal Statute ◽  
Insurance Exchanges

Young adults between the ages of 18-34 are most likely to lack health insurance in the United States. The Affordable Care Act (ACA), a federal statute signed into law in 2010, contains provisions specific to increasing access to health insurance for young adults including the provision that persons under 26 can stay on their parents’ insurance. While the reasons for uninsurance among young adults have been documented, how they operate and are perceived on an individual level have not been explored in great detail. Further, it is poorly understood how the ACA policies and the state health insurance exchanges can serve young adults. Thus, we interviewed uninsured young adults aged 18-35 in northeastern Minnesota and northwestern Wisconsin and used inductive thematic analysis to explore these issues. Findings suggest that young adults don’t feel at risk for health problems and therefore have low levels of health insurance literacy and place little value on health insurance. Multiple barriers to health insurance coverage, including the provision about staying on a parent’s policy, persist despite the ACA. Our findings also suggest valuable lessons for state health insurance exchanges on how to better serve this population.

scholarly journals Have the ACA's Exchanges Succeeded? It's Complicated

2020 ◽  
Vol 45 (4) ◽  
pp. 661-676 ◽  
Author(s):  
David K. Jones ◽  
Sarah H. Gordon ◽  
Nicole Huberfeld
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Health Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Rapid Evolution ◽  
Middle Income ◽  
State Variation ◽  
Individual Decisions ◽  
Insurance Exchanges

Abstract The fight over health insurance exchanges epitomizes the rapid evolution of health reform politics in the decade since the passage of the Affordable Care Act (ACA). The ACA's drafters did not expect the exchanges to be contentious because they would expand private insurance coverage to low- and middle-income individuals who were increasingly unable to obtain employer-sponsored health insurance. Instead, exchanges became one of the primary fronts in the war over Obamacare. Have the exchanges been successful? The answer is not straightforward and requires a historical perspective through a federalism lens. What the ACA has accomplished has depended largely on whether states were invested in or resistant to implementation, as well as individual decisions by state leaders working with federal officials. Our account demonstrates that the states that have engaged with the ACA most consistently appear to have experienced greater exchange-related success. But each aspect of states' engagement with or resistance to the ACA must be counted to fully paint this picture, with significant variation among states. This variation should give pause to those considering next steps in health reform, because state variation can mean innovation and improvement but also lack of coverage, disparities, and diminished access to care.

scholarly journals Estimated Costs of a Reinsurance Program to Stabilize the Individual Health Insurance Market: National- and State-Level Estimates

2019 ◽  
Vol 56 ◽  
pp. 004695801983606 ◽  
Author(s):  
Coleman Drake ◽  
Brett Fried ◽  
Lynn A. Blewett
Keyword(s):  
Health Insurance ◽  
Financial Risk ◽  
Medical Expenditure Panel Survey ◽  
Insurance Coverage ◽  
Health Spending ◽  
Medical Expenditure ◽  
Insurance Market ◽  
Individual Health ◽  
Health Insurance Market ◽  
The Individual

Reinsurance, an insurance product designed to protect health insurers against the financial risk of covering high-cost enrollees, has attracted bipartisan policy interest as a mechanism to stabilize individual health insurance markets. Three states—Alaska, Minnesota, and Oregon—have implemented state-based reinsurance programs under the Affordable Care Act’s 1332 State Innovation Waivers, and reinsurance waivers have been approved though not yet enacted in Maine, Maryland, New Jersey, and Wisconsin. In this article, we estimate the costs of implementing national and state-based reinsurance programs using health spending data from the 2007-2016 Medical Expenditure Panel Survey and state demographic and health insurance coverage data from the 2015-2017 Current Population Survey Annual Social and Economic Supplement. We project that a reinsurance program with an 80% payment rate for expenditures between $40,000 and $250,000 would cost $30.1 billion from 2020-2022. We observed considerable variation in reinsurance programs and estimated costs between the 4 states we examined: California, Florida, Illinois, and Texas. Our projections provide updated estimates of the costs of implementing federal reinsurance programs for the individual health insurance market.

The Individual Mandate: Implications for Public Health Law

2011 ◽  
Vol 39 (3) ◽  
pp. 401-413 ◽  
Author(s):  
Wendy E. Parmet
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Universal Coverage ◽  
Health Law ◽  
Healthy Individuals ◽  
Sick People ◽  
Patient Protection ◽  
Death Spiral ◽  
Individual Mandate ◽  
The Individual

No provision of the Patient Protection and Affordable Care Act (PPACA) has proven to be more contentious than the so-called “individual mandate.” Starting in 2014, the mandate will impose a penalty on non-exempt individuals who lack health insurance. According to Congress, the mandate is essential to ensuring near universal coverage. Without it, PPACA’s insurance reforms will lead healthy individuals to delay purchasing health insurance until they require medical care, resulting in risk pools with a disproportionate share of high-risk people. The price of insurance will then climb, causing more and more not-so-sick people to forego health insurance. The resulting “death spiral” will make insurance unaffordable to many more Americans.

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