ACA's Mandate To Buy Coverage May Be GOP-Friendly | Healthcare and Technology news | Scoop.it

Whether it’s a penalty to pick a drug plan under Medicare or the new Republican proposal to replace the Affordable Care Act or the President’s health law alone, penalties abound for being uninsured.

A new analysis by the Urban Institute said “individual responsibility” requirements akin to the controversial individual mandate included in the Affordable Care Act requiring individuals to buy coverage or face a tax penalty also exist in other health reform proposals and existing health insurance programs.


Some, like the Medicare Part D drug coverage for seniors and Medicare Part B’s physician services for the elderly, have been in place for years. Another, a new Republican proposal to replace the ACA, also has its penalties.


The so-called “Patient Choice, Affordability, Responsibility, and Empowerment Act” or PCARE, proposed by Republican Rep. Fred Upton of Michigan and GOP Sens. Orrin Hatch of Utah and Richard Burr of North Carolina would “impose strong penalties on the uninsured,” Urban Institute health policy researchers Linda Blumberg and John Holahan wrote in their analysis out this week called, “the New Bipartisan Consensus for an Individual Mandate.”


“Specifically, if individuals fail to maintain continuous coverage, they can be medically underwritten or effectively denied insurance in the nongroup market,” the Urban Institute’s authors wrote of the Hatch-Burr-Upton legislation. “Medicare Parts B and D also have provisions that penalize individuals for failing to promptly enroll in coverage for the same reason, yet this approach to an individual mandate has not been controversial.”


All of the proposals share the common thread that health insurance, particularly coverage that involves the private insurance market, need an individual responsibility component to ensure healthy people are in the insurance risk pool. Without healthy people buying coverage and paying premiums, claims submitted largely by sick policyholders would lead to soaring health care costs.


The individual responsibility provision has long been the stance of health care interests like the American Medical Association and the health insurance lobby, America’s Health Insurance Plans, which represents Aetna (AET), Cigna (CI), Humana (HUM), UnitedHealth Group (UNH) and most Blue Cross and Blue Shield plans.

“If you want to keep a private market-centered approach and prevent discrimination in insurance against those with health problems, you have to have a mechanism that brings in and holds in the healthy,” Blumberg, seniors fellow at the Urban Institute’s health policy center told Forbes in an interview. “You have to have an individual mandate to hold the healthy into the insurance risk pools.”


The GOP’s Obamacare replacement requires individuals to have insurance “continuously for 18 months to be guaranteed access to a private nongroup insurance policy,” the Institute said in a statement accompanying their analysis. Meanwhile, the ACA imposes tax penalties for those individuals who go without insurance for more than three months in any given year. And Medicare Parts B and D have penalties that are much steeper than the ACA’s for those who delay enrolling after they become eligible.


“Under both programs, penalties are assessed on those who enroll, disenroll and then enroll again,” the institute fellows wrote.