White House Proposes Individual Mandate Rules

Cheryl Clark, January 31, 2013

The Obama administration's proposed rules governing the individual mandate include such extensive exemptions that only 2% of the population would owe a penalty, or "shared responsibility payment" for not having coverage under a health plan.

The proposed rules, issued Wednesday, came in the form of two documents, one from the Internal Revenue Service and the other from the Health and Human Services Agency. They detail the controversial individual mandate portion of the Patient Protection and Affordable Care Act, which requires that Americans carry health insurance coverage by 2014. 

As spelled out in the PPACA, "applicable individuals" must pay a penalty if they don't have employer-sponsored health coverage, don't have their own health plan, and are otherwise not exempted, starting next year.

Under the proposed rules, however, large portions of the population would be exempt from paying the penalty, which would be relinquished through  annual tax filings.

Those who would be exempt include taxpayers with incomes below the filing threshold, those who can not afford coverage, members of Indian tribes, people who qualify for hardship exemptions, individuals who have short coverage gaps, those who don't want to purchase health insurance for religious reasons, members of "health sharing ministries," and individuals who are incarcerated.


Also, the penalty would not apply to any taxpayer "for whom coverage is unaffordable, who has other good cause for going without coverage, or who goes without coverage for only a short time," the administration said in a fact sheet.

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