Behind the Waning Support for ACA's Individual Mandate

Philip Betbeze, February 4, 2011

Amazing what you'll find when you spend a few minutes each day cleaning out your email box. Doing so was one of my New Year's resolutions, and one I've actually been able to stick to for more than a month. Anyway, while doing this mundane and hated task, I ran into a survey that I found pretty interesting, given this week's developments with health reform in the court system.

Here's what was interesting about one press release I stumbled across: Almost two years ago today, public support for the individual mandate included in healthcare reform legislation, which came to be known as the Patient Protection and Affordable Care Act, was actually pretty strong, if a scientific survey from the influential journal Health Affairs is to be believed.

The survey focused on the public support for the mandate. In short, in a telephone survey of 1,704 adults age 18 and older, conducted between Feb. 14 and Feb. 24, 2008, half of the respondents were asked about a standalone mandate. The other half were asked about a shared-responsibility plan containing an individual mandate. Support was somewhat tepid for the standalone mandate, at 48%. However, 59% of those surveyed supported an individual mandate when it was part of a shared responsibility among government, employers, insurers, and individuals.

That kind of mandate is what eventually made it into the legislation. Beginning in 2014, among other requirements, insurers are no longer allowed to exclude individuals based on pre-existing conditions. They're also prohibited from capping benefits for their insured population in a lifetime maximum methodology. Government is doing its part by covering many of the previously uninsured. Employers (at least those who employ at least 50) are being forced to either provide a certain level of insurance coverage for their employees, or pay a schedule of penalties based upon their coverage levels. Individuals, well, they'll be required to carry health insurance, or pay a penalty themselves, albeit a very small one.

Yet it seems fairly likely, based on developments this week, that despite that support, the mandate is in serious trouble—not from the public, but from the courts. And if the individual mandate is in trouble, so is the entire law.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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