|
Volume 13 Number 20 News: Access Requiring individuals to purchase health insurance is essential to achieving universal coverage, because a voluntary system would leave too many individuals uncovered, lead to adverse selection, and make it more difficult for the federal government to provide funding, according to a study released Jan. 30. The study by the Urban Institute said that without a mandate that individuals purchase coverage, health reform "would fall well short of achieving universal coverage." Adopting reforms without an individual mandate could leave as many as half of those without health insurance still uncovered, said the study, Do Individual Mandates Matter? Massachusetts has adopted a health reform plan with an individual mandate, and Democratic presidential candidates Sens. Hillary Clinton (D-N.Y.) and Barack Obama (D-Ill.) have proposed plans for universal coverage with requirements for individuals to purchase coverage and for employers to offer or help pay for coverage, according to a Commonwealth Fund report from 2007 (No. 201 HCDR 10/18/07 a0b5g3a1d7 "Opponents of an individual mandate argue that they can come close to universal coverage with a combination of income-related subsidies, more options for purchasing affordable coverage (e.g., through purchasing pools), and administrative mechanisms for facilitating enrollment in insurance," the Urban Institute study said.
Many Would Be Left Uninsured
"The most recent data indicate that there are 47 million uninsured people in the United States. Even if subsidies, benefits, and administrative simplifications are sufficient to reach two-thirds of the uninsured (a reach beyond what any study to date has shown for a voluntary system), this would still leave 15.5 million people uninsured," it added.
A voluntary coverage system also would be likely to attract high-cost individuals, driving up the cost of coverage, unless the federal government intervened, according to the study.
"Absent such government intervention, higher premiums would further dissuade enrollment by younger adults and the healthy, accelerating the increase in premiums," it said.
The cost of voluntary expansion with government subsidies also would not be substantially lower than a plan that provides universal coverage, according to the study.
Health care reform could be financed in part by using Medicare and Medicaid funding for safety net providers, the study said. But these providers could argue that they should retain these funds under a voluntary system because they would still have to treat millions of individuals without health care coverage, it added.
The study said enforcement could be carried out via the tax code by deeming everyone to have insurance and then assessing penalties for those who could afford coverage but failed to get it.
Tax penalties for Massachusetts residents who can afford health insurance but fail to obtain it will range from $210 to $912 in 2008, the state's Department of Revenue said Dec. 31, 2007.
The study is available.
|
