3 Weaknesses of Obamacare’s Individual Mandate

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It is a well-known fact that the individual mandate is the cornerstone provision of the Affordable Care Act; the employer mandate is merely a supporting player, as made abundantly clear when the Obama administration decided last summer to delay by one year that portion of the health care reform law while continuing to push forward with the implementation of its counterpart — the individual mandate — despite some evidence that the essential computer system needed to support insurance enrollment was unready. As that postponement suggests, the complexities of the health care system made its reform somewhat unwieldy.

Because the Affordable Care Act was designed as a build-on to the existing system, expanding health care coverage to America’s millions of uninsured by filling in the gaps left by Medicare and Medicaid, the reform is “a complex and somewhat ugly patch on a complex and somewhat ugly system,” according to Princeton University’s Uwe Reinhardt. But there will be several moments in the next months and years when the Affordable Care Act will show itself to have been either a successful reform of the American health care system or merely a “complex and ugly patch.” Regardless of whether it is a success or a failure, the law and its individual mandate is complicated, and there are many moments when problems could arise and many places where weakness could develop.

With the announcement that three million people have signed up for private policies through the insurance marketplaces set up under the law, it seems that the major front-end problem plaguing the early rollout of the exchange system has been solved: the webportal — healthcare.gov, which links the thirty-six federally-facilitated exchanges — is allowing insurance customers to enroll without error messages and long waiting times. Total numbers may be lagging behind the projections made by the administration in September, but the exchanges are nearer to hitting the monthly targets. As Bloomberg’s Joshua Green wrote, “It no longer seems inconceivable that 7 million could sign up by March 31st, as the [Congressional Budget Office] had originally projected.” The problem is that it remains unclear how many of the enrollees are young and healthy and how many were previously uninsured; those are key metrics that will determine the effectiveness of the reform.

The lack of incentives for young, healthy, and therefore cheap-to-insure individuals to sign up for coverage and the possibility that coverage may not be affordable enough for the previously uninsured to enroll are hallmarks of the reform’s complexity and its problems.

Here are some weaknesses with Obamacare’s individual mandate.

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