What If Every State Had Its Own Individual Mandate?


The Affordable Care Act required most Americans to enroll in a health insurance plan or pay a financial penalty — until Congress got rid of the penalty as part of last year’s tax law. The Congressional Budget Office predicts that elimination of the mandate penalty, which was designed to stabilize insurance markets by encouraging the healthy to purchase a plan, will lead to higher premiums and millions of Americans losing their coverage.

But what would happen if every state followed the lead of Massachusetts and New Jersey by enacting its own individual mandate to replace the ACA’s version? According to a new Commonwealth Fund/Urban Institute report, it would result in close to 4 million Americans gaining health insurance and a nearly 12 percent average drop in premium costs.

According to the report, premiums in New Mexico would decrease more than 20 percent under a state-enacted individual mandate, while premiums would drop 15 percent or more in Colorado, the District of Columbia, Kentucky, Nevada, North Dakota, Washington, and West Virginia.

“Although the repeal of the individual mandate penalty will have negative effects across our health care system,” says the Urban Institute’s Linda Blumberg, “states can act to keep their health insurance markets stable and affordable by offsetting the expected coverage losses and premium increases beginning in 2019.”

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