Health Insurance - Individual Mandate

What’s the latest in the Senate on requiring individuals to buy health insurance?

Are specific procedures to enforce it spelled out?

When would the requirement begin?

How would an “if you can afford it” exemption be monitored?

This is something I wish critics of HCR had focused more on.
But seeing as how that basically amounts to a sop for the insurance industry (even if it wasn’t necessarily meant to be so), I shouldn’t have expected conservatives to make a big stink about that part of the bill. The fact that they chose to focus on red herrings like death panels instead just goes to show that this was just one big political game for them, instead of an effort to address any real concerns they might have had.

I assume, without having read the bill, that the procedures will be written after final passage by the Health and Human Services Department. The exchanges, and therefore mandate, aren’t scheduled to take effect until, IIRC, 2013 or 2014 (that’s one discrepancy between the House and Senate versions that needs to be worked out).

joebuck, I don’t think your comments are entirely appropriate for GQ, but since you’ve aised them, the mandate wasn’t a sop to the insurance companies. It was the necessity to keep insurance costs manageable. The insurance industry, through this bill, is required to insure basically anybody who asks. Right now, they don’t sell insurance to people with preexisting conditions or other factors that make them likely to incur a lot of medical cost. This will stop, as will policies with lifetime (and yearly, IIRC) caps. But that means that the insurers will, without more, have huge additional liabilities.

By itself, this would lead to skyrocketing rates, as insurers had to cover all those additional costs. (Insurance companies are grossly inefficient, it seems, but they’re not high-profit businesses, so there’s a very limited amount of simple belt-tightening that they could do. And why would they?) Therefore, the bill also demands that the “young invincibles” – namely, those 20-something morons who think they don’t need insurance because they’ll never get sick – buy into the pool.

This gives the insurance companies lots of new cheap customers to defray the costs of the new sickly customers they’re now required to insure. But it’s good for the young invincibles, too, because some smallish but non-trivial percentage of them do end up getting cancer, or Crohn’s, or hit by a bus. For those that developed these illnesses/injuries without insurance, it meant bankruptcy for themselves and possibly their family, inconsistent care, and in at least a few thousand cases a year, death. And it also meant higher health-care costs for all the rest of us, too, as hospitals and other providers jack up their rates on those who can pay in order to subsidize cheap or pro bono care for those who cannot. (Also, lack of insurance probably tends to make care more expensive for a given disease, because the sick person without insurance defers treatment until he’s rushed to the emergency room at death’s door, when the illness has had additional time to spread/intensify/etc.)

There are problems with the bill, and certainly it’s not ambitious enough, but the mandate isn’t one of them. It’s a feature, not a bug.


Thank you for taking the time to explain, Cliffy. I understand that this is basically a necessary evil.
But I still wonder if this bill is really going to do all that much to keep costs down. Those twenty-somethings without insurance don’t go uninsured because they think they’re invincible. They’re doing so because they simply can’t afford insurance. Is this bill really going to do much good for some underemployed kid fresh out of college who’s already having trouble making ends meet?
Believe me, I’m all for HCR, and am in full agreement with you that this bill didn’t go far enough. Hell, in my ideal world, the government would not only institute single payer but bury the insurance lobby and piss on its grave. I just feel that they sacrificed too much without addressing the questions I raised above, just so they can say they passed a bill.

Cliffy, at the time of the last decent summary I could find, the ability to impose annual (but not lifetime) coverage limits was inserted back into the Senate bill. That particular fact is far more of a poison pill than the individual mandate in the opinion of most of the progressives who were calling for the bill to be killed and for the Senate to begin the process of reconciliation with the House to come up with a final bill.

ABC News and other news I’ve watched said the current bills would still leave 19,000,000 Americans uninsured? So what’s up with this? Would it even require people to buy insurance?

The mandate is in both the house and senate versions of the bill, but that’s not really a requirement. The estimated 19 million are those that decide to pay the tax penalty rather than buy insurance, or they come under the financial hardship exception. And probably a few other groups that slipped through the cracks as well.

What’s the burden of proof on the religious objections? Any idea how many people would claim that exemption?

Here’s my question. With the public option gone, what is to prevent insurance companies from charging huge premiums once it is illegal to not be insured?

You probably just have to sign a statement saying you are a member of a religion like Christian Scientist that does not believe in modern medicine.

Schools require kids to get vaccinated but many districts allow an exception for religious reasons. Turns out that some parents are lying, they say they are skipping vaccines for religion but in reality they are just afraid of vaccines. (due to claims of autism being caused by vaccines)

How about the liklihood that another company will come along and offer the same level of insurance for less money?

Sorry if I missed this, but exactly when does all of this begin?:confused:

Luckily, my COBRA was extended for three months, but after that, it’s going to be the VA.

It might be the VA anyway, because all day long, I’ve been on one VA site or another checking things out, and apparently, since I was honorably discharged I can get care, but because I’m still covered by COBRA, the VA will bill THEM for any services. This MIGHT even turn out to be more cost-effective anyway, since the co-pay vor VA pharmacy meds are only $8.00.



The public option wasn’t going to help this much anyway. As noted, the primary driver of low costs is going to be competition from other insurers. The mandate did have this effect is Massachusetts.


Quasi, this stuff won’t start for a few years still.

I have to wonder in 50 years if this is going to cause what Social Security is facing today… way more people in their 60s-80s (current generation of 10-30 year olds) who need health coverage/care than there are health 20 year olds at that time to pay into this public health insurance system.

We were already facing this situation with Medicare, since health insurance for the 65+ crowd was already public.