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COVERAGE: Myths About an Individual Mandate: Enforcement
Myth: An individual mandate is not enforceable.
Fact: Switzerland and the Netherlands have successfully enforced an individual mandate to purchase health insurance. Similarly, some American states have achieved close to 100 percent compliance with a mandate to purchase car insurance.
Enforcing a requirement to purchase health insurance will likely a take series of integrated approaches. Some possible models include:
- Electronic Information Sharing: In 2001, Georgia implemented its Electronic Insurance Compliance System for car insurance. In less than two years, Georgia cut its uninsured motorist rate from 20 percent to two percent. For health, electronic information sharing could increase compliance while helping identify and enroll individuals who are eligible for public plans and subsidies.
- Proof of Insurance on Tax Returns: While not all low-income individuals file tax returns, the American tax system could be used to identify those people in mid- to high-income brackets who are still not insured.
- Auto-enrollment/Insurance checks at point of service: Auto-enrollment into the lowest cost plan available (public or private) provides a way of changing the default status of Americans from unisured to insured. The New America Foundation has outlined how such a program might work to ensure coverage and payment without interfering with care.
Check back tomorrow when we'll examine common myths about mandates and covering all Americans. For more in depth discussion, read New America's recent issue brief.
Myths about the Dutch Individual Mandate: enforcement
Some in the Dutch Government are exploiting the debate in the United States and have started their own debate during the last couple of weeks and are now looking into a fine for the approximately 200,000 people that are not paying their premium in the Netherlands.
Countries, including the US and the Netherlands, should learn from each other instead of playing politics.
I was born and raised in the Netherlands and my husband was stationed there twice. We currently live in the United States while my family still lives in Holland. The premiums have risen every year both before and after the introduction of the new system in Holland in 2006, much faster then incomes have risen. Further increases are expected in the coming years. My mother is disabled and her premium is now 125 euros per month for the mandatory basic package and the additional package. She receives a few euros back through a monthly tax rebate. Even though it's required to pay health insurance in the Netherlands, she receives a bill in the mail every month. My sister is a 38-year old deaf woman who holds a Bachelors degree but regardless of her resume she's not been able to find work in the last two years. The Dutch with Disabilities Act does not exist. My sister, who is also a heart, asthma, and reumatory arthritis patient, cannot afford the additional health coverage.
Not only the prices of the premiums have risen over the last couple of years. Holland used to be a country where you would hardly see a food bank. Today the food banks have spread around the country and they still cannot meet the demand. If it wasn't for a family network our family in Holland would not be able to pay their premiums just like many of our friends can't afford it in the US and just like some of our friends in Holland.
We served the United States of America for 20 years. The premiums for our coverage, a government program that has no mandate, are much lower then those of our family in Holland. We are of the opinion that people with low incomes cannot be excluded from the serious discussions about mandates and enforcement, but that too often they are excluded. The same for our 25 million American veterans, they are among the people in this world that have actually lived and are living in other countries.
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