Mandate

Myth: An individual mandate will stifle market competition.

Fact: An individual mandate, coupled with insurance market reforms and subsidies, would make markets work more effectively and efficiently. By reducing the risk of adverse selection, an individual mandate would force insurers to compete based on price and quality, not underwriting and marketing.

Myth: An individual mandate is not necessary to ensure that all Americans have health insurance coverage.

Fact: Many Americans who are eligible for public insurance at little to no cost do not enroll, while others who could afford private health insurance choose not to buy. This suggests a mandate is necessary to approach 100 percent enrollment.

• Three highly respected health economists concluded that an "individual requirement to buy or acquire health insurance is a necessary element of any proposal that aims to cover all Americans."
• According to research by the Urban Institute, more than 15.5 million people would still be uninsured under a system with generous benefits, subsidies, and sufficient administrative simplification—but no mandate
• Researchers have found that when insurance is affordable, compliance is easy, and enforcement is done right, mandates are likely to succeed.

Check back tomorrow when we'll examine common myths about mandates and stifling competition. For more in depth discussion, read New America's recent issue brief.

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:

Can New Jersey afford health reform? Can New Jersey afford to do without health reform? We traveled north to the Garden State today as our very own Len Nichols, (see Len's presentation here) the AARP, the Rutgers Center for State Health Policy, Governor Jon Corzine, Representative Frank Pallone, and a host of state lawmakers addressed those two key questions.

Most of the buzz surrounded New Jersey State Senator Joseph Vitale, chairman of the health committee, who has introduced legislation that would seek to cover all New Jerseyans in two phases during a three-year-period:

Myth: If individuals choose to be uninsured, there are no consequences to society.

Fact: The uninsured increase the price of premiums for the insured and drive uncompensated care costs that taxpayers and health care providers must absorb. They place undue strain on Emergency Departments and other sources of care that impact all of us.

As we’ve noted before, requiring individuals to purchase health insurance—the so-called “individual mandate”—has figured prominently in the national debate on health reform. From California to Massachusetts to the campaign podium, the concept is a central point of the reform dialogue.

We believe that requiring all Americans to purchase health insurance, coupled with low-income subsidies and insurance market reforms, is a necessary component of a sustainable health system that seeks to cover all Americans. Given the constant echo chamber of op-eds and punditry, we felt it was useful to take a step back to examine common myths about the "individual mandate."

Drawing from a recent issue brief by the New America Foundation, each day this week, we will examine a common myth about the individual mandate. They are:

• Monday: Societal Costs of the Uninsured
• Tuesday: Affordability
• Wednesday: Enforceability
• Thursday: Covering All Americans
• Friday: Stifling Competition

The big health policy difference between Barack Obama and Hillary Clinton is, naturally, the question of the individual mandate. We here at New America do support the idea of requiring everyone to be insured (with adequate subsidies for low-income people). But we are glad that the dispute is increasingly being seen as a disagreement about means, not a war about ends, that can be resolved reasonably amicably when Congress takes up health reform next year. And we suspect that outside the health care cognoscenti, most people would agree with the New York Times piece this weekend that called it a fight about "the narrowest of bands in a broad policy spectrum." We also liked these two recent Op-Eds in the Los Angeles Times on mandates. Jacob Hacker rightly reminds his fellow mandate supporters that the focus needs to be on coverage itself, not mandates. And Ezra Klein explains why we'll all still be complaining about the intrinsic flaws of health insurance if we don't get everybody in the pool. We also note that we've seen several good "big picture" pieces about the rationale for health reform, including this recent one on NBC featuring New America's own Len Nichols.