Insurance Mandate Research Articles

Estimating Obamacare's Effect on State Medicaid Expenditure Growth: A Study of Five Most Populous U.S. States

Unless repeal attempts succeed, the Patient Protection and Affordable Care Act of 2010 (ObamaCare) promises to increase state government obligations on account of Medicaid by expanding Medicaid eligibility and introducing an individual health insurance mandate for all US citizens and legal permanent residents. Once ObamaCare becomes fully effective in 2014, the cost of newly eligible Medicaid enrollees will be almost fully covered by the federal government through 2019, with federal financial support expected to be extended thereafter. But ObamaCare provides states with zero additional federal financial support for new enrollees among those eligible for Medicaid under the old laws. That makes increased state Medicaid costs from higher enrollments by “old-eligibles” virtually certain as they enroll into Medicaid to comply with the mandate to purchase health insurance. This study estimates and compares potential increases in Medicaid costs from ObamaCare for the five most populous states: California, Florida, Illinois, New York, and Texas.The results suggest that Medicaid costs would increase considerably even on a pre-ObamaCare basis in California, Florida, and Texas — states with rising populations across many Medicaid eligibility and enrollment groups by age and gender. Cost increases on a pre-ObamaCare basis are projected to be smaller in Illinois and New York — states whose populations are projected to remain generally stagnant or decline during the next two decades. On a post-ObamaCare basis, the projected cost increase is small for California — just 4.5 percentage points in cumulative costs during 2014-23 compared to the pre-ObamaCare ten-year total cost projection. That’s because enrollment rates among “old-eligibles” are already high in California on a pre-ObamaCare basis, implying little scope for additional enrollment increases from the introduction of ObamaCare. In Florida and Texas, projected post-ObamaCare increases in Medicaid costs are larger, because these states are projected to have larger populations of non-enrolled “old eligibles.” Illinois and New York exhibit historically stable or declining enrollment rates among “old eligibles,” implying larger potentials for higher enrollments and increased costs when ObamaCare becomes effective after the year 2014.

The Importance of the Individual Mandate — Evidence from Massachusetts

The most contentious aspect of the recent national health care reform is the individual insurance mandate. Data from Massachusetts may predict the mandate's additive effect on reducing adverse selection, beyond simply offering subsidized, community-rated insurance.

Reform Law's Insurance Mandate Unconstitutional, Court Says

At least one legal expert says the Virginia ruling flies in the face of court rulings in recent decades that have had a pragmatic approach to the Constitution's commerce clause, saying Congress has the right to regulate policies that have a substantial impact on commerce.

Judge Strikes Down Health Insurance Mandate

Judge Strikes Down Health Insurance Mandate

Judge Strikes Down Individual Health Insurance Mandate

Judge Strikes Down Individual Health Insurance Mandate

Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses.

We examine the effects of state health insurance mandates requiring coverage of screening mammograms. We find evidence that mammography mandates significantly increased mammography screenings by 4.5-25 percent. Effects are larger for women with less than a high school degree in states that ban deductibles, a policy similar to a provision of federal health reform that eliminates cost-sharing for preventive care. We also find that mandates increased detection of early stage in-situ pre-cancers. Finally, we find a substantial proportion of the increased screenings were attributable to mandates that are not consistent with current recommendations of the American Cancer Society.

AMA Holds Firm on Support of Health Insurance Mandate

Support for the individual mandate to buy insurance was approved as AMA policy in 2006 and is necessary for other health insurance market reforms contained in the new health care reform law.

WILL HEALTH INSURANCE MANDATES INCREASE COVERAGE? SYNTHESIZING PERSPECTIVES FROM HEALTH, TAX, AND BEHAVIORAL ECONOMICS

This paper provides an analytical framework for evaluating the effects of individual health insurance mandates on coverage. That framework draws from three literatures — health economics, tax compliance, and behavioral economics — to identify the factors that affect people's responses to health insurance mandates. The health economics literature explains how people value health insurance and how changes in its costs affect coverage. The tax compliance literature indicates that the probability of detection and peoples attitudes toward risk affect perceptions of those costs. The salience of the mandate and social norms — factors from the behavioral economics literature — also may affect coverage decisions.

The Private Action Requirement

The crucial issue in the ongoing litigation over the individual health insurance mandate is whether there is a constitutional distinction between the congressional regulation of action and inaction. Critics of the Patient Protection and Affordable Care Act say that Congress lacks the authority under the Commerce Clause to make citizens buy health insurance against their will. The individual mandate, they contend, is not a regulation or a prohibition of economic activity, which fall within the commerce power. Instead, the requirement is a regulation of inactivity (or compelled activity) that is unprecedented under the Commerce Clause and invalid.

Mulling over Massachusetts: Health Insurance Mandates and Entrepreneurs

The author provides preliminary and provocative results regarding the impact of health insurance mandates on the propensity of entrepreneurs to start new organizations. In keeping with a well–observed propensity for individuals to adjust their economic calculations in anticipation of future costs/benefits, the evidence suggests that when confronted with such mandates, potential entrepreneurs may either abandon entrepreneurial ambitions or seek to minimize mandate costs through jurisdictional arbitrage with appreciable implications for state and national level approaches to health care, health insurance provision, and workers.

Insurance mandates, embryo transfer, outcomes—the link is tenuous

To examine the relationship between state insurance mandate status and the number of embryos transferred in assisted reproductive technology cycles, we conducted a retrospective analysis of clinics reporting to the publicly available national Society for Assisted Reproductive Technology registry. We found that clinics in states with comprehensive mandates transferred between 0.210 and 0.288 fewer embryos per cycle depending upon patient age, and were more likely to transfer fewer embryos than recommended for older women; however, the relationship between state mandate status and clinic birth and multiple birth rates varied by age group.

Purchase Health Insurance or Else: Why Individual Health Insurance Mandates Enacted by the Federal Government are Unconstitutional

On March 23, 2010, President Obama signed comprehensive health care legislation into law. Although historic, attorneys general from twelve states have filed suit against the federal government challenging the constitutionality of the bill. Specifically, the constitutional challenges focus on the individual health insurance mandate included in the bill. The mandate requires that all citizens have health insurance by 2014 or pay a fine. This Comment analyzes the congressional powers provided by the United States Constitution and the Supreme Court's interpretation of those powers to show why the individual health insurance mandate is unconstitutional.

Health Care Reform in Massachusetts: Implementation of Coverage Expansions and a Health Insurance Mandate

Much can be learned from Massachusetts's experience implementing health insurance coverage expansions and an individual health insurance mandate. While achieving political consensus on reform is difficult, implementation can be equally or even more challenging. The data in this article are based on a case study of Massachusetts, including interviews with key stakeholders, state government, and Commonwealth Health Insurance Connector Authority officials during the first three years of the program and a detailed analysis of primary and secondary documents. Coverage expansion and an individual mandate led Massachusetts to define affordability standards, establish a minimum level of insurance coverage, adopt insurance market reforms, and institute incentives and penalties to encourage coverage. Implementation entailed trade-offs between the comprehensiveness of benefits and premium costs, the subsidy levels and affordability, and among the level of mandate penalties, public support, and coverage gains. National lessons from the Massachusetts experience come not only from the specific decisions made but also from the process of decision making, the need to keep stakeholders engaged, the relationship of decisions to existing programs and regulations, and the interactions among program components.

Market Inefficiency, Insurance Mandate and Welfare: U.S. Health Care Reform 2010

Market Inefficiency, Insurance Mandate and Welfare: U.S. Health Care Reform 2010

Massachusetts health insurance mandate: effects on neurosurgical practice

Massachusetts' health insurance mandate and subsidized insurance program, Commonwealth Care, have been active for 2 years. The financial impact on the neurosurgery division and demographics of the relevant patient groups were assessed. The billing records of neurosurgical patients from January 2007 to September 2008 were collected and analyzed. Commonwealth Care comprised 2.2% of neurosurgical inpatients, and these patients did not have significantly different acuity or lengths of stay from the average. Length of stay of MassHealth patients was significantly greater, although acuity was significantly lower than the average. Increased free care reimbursement and increased MassHealth/Commonwealth Care enrollment resulted in a net gain in reimbursement of hospital charges. The increased insurance rates have resulted in increased reimbursement for the neurosurgical division.

Crisis on Campus: Student Access to Health Care

College-aged adults are an overrepresented group in the uninsured population of the United States, and traditionally underserved minorities are disproportionately affected. Students with private health insurance are often functionally uninsured as well, since most schools refuse to accept this traditionally elite calling card on campus. Consequently, the large uninsured and functionally uninsured populations often rely on school-sponsored health insurance plans for access to care. These plans have uneven coverage, limited benefits, exclusions and high co-pays and deductibles, and provide little health care security for their beneficiaries. Further, schools and insurance companies have profited substantially from these student plans, raising the possibility of a conflict of interest, with school-sponsored plans that may be focused on financial benefits to schools rather than the health of students. In addition, these plans may violate public policy and consumer protection laws by charging those who do not enroll in school-sponsored plans higher prices and by disingenuously claiming "competitive" rates when advertising to students. Public efforts at a student mandate, such as in Massachusetts, although successful in increasing the number of students with health insurance, have failed to provide adequate access to care. A focused policy must be put into place to ensure that students can effectively and efficiently access needed health care services on campus. In support of this effort, a proposed statute is provided herein. This bill would amend the Higher Education Opportunity Act to create a student health insurance mandate. School-sponsored plans, as well as private plans with comparable coverage, would be required to fulfill a minimum standard benefits plan. Reasonable exclusions and limitations would be allowed, based on standard practices in commercial health insurance plans. The statute would require a minimum percentage of premiums to be spent on health care, with any excess rebated to students. It would also require schools to accept a student's private health insurance for campus services to avoid forcing students to pay more than once for care. As part of this mandate, a portion of the surplus retained by schools billing private insurers would be allocated to create health insurance scholarships for uninsured students. Finally, the definition of "cost of attendance" would be adjusted to ensure that financial aid calculations take into account health insurance premiums.

The National Individual Health Insurance Mandate

On March 23, 2010, President Obama signed into law the nation's first comprehensive health care reform bill, the Patient Protection and Affordable Care Act. Within weeks, twenty states filed lawsuits challenging the constitutionality of its most politically charged feature--an individual purchase mandate. By 2014, the bill requires most individuals to have health insurance. With certain exceptions (pertaining to income level and religious objections), individuals without qualifying coverage will pay an annual tax penalty reaching the greater of $695 ($2,085 per family maximum) or 2.5 percent of household income. (1) If anything, the tax penalty is too low compared with the cost of insurance, so it may not provide sufficient incentive for healthy individuals to purchase insurance. But it remains controversial because it compels people to purchase coverage they choose not to have, raising the question whether Congress can lawfully and ethically require individuals to contract with, and transfer money to, a private party. (2) To be sure, the individual mandate lacks a clear American precedent. (It has worked successfully in other countries, such as Australia.) Compulsory automobile insurance, for example, is a state requirement, operates as a condition of exercising the privilege of driving, and requires coverage for injuries to others (not the insured). Personal Freedom and Collective Goods in Conflict Opposing a mandate is understandable when viewed from an individual perspective: it interferes with economic freedom and constrains personal choice. In economic terms, it represents a compelled cross-subsidy. However, when viewed from a collective perspective, the mandate offers valuable social benefits. The absence of health insurance creates harmful consequences, including lower quality of life, increased morbidity and mortality, and higher financial burdens.(3) Since these consequences fall mostly on those who lack insurance, the decision to seek insurance arguably should be left to them. However, government is responsible for the wellbeing of the community, not particular individuals. Even if the decision were primarily self-regarding, its effects--illness and death--can be felt by all. Many individuals cannot afford insurance, but others choose not to insure; over nine million people with annual incomes over seventy-five thousand dollars had no coverage in 2007. (4) Yet many previously healthy people suffer illness or injury and end up requiring treatment in emergency departments, most of which is uncompensated. Free riders rely on society to pick up the costs (forty-three billion dollars in 2008) through higher insurance premiums (above one thousand dollars annually) and higher taxes (such as hospital subsidies, Medicaid, and Medicare). Individuals often delay purchasing insurance until they become ill, creating an adverse problem for insurers. At its worst, free-riding and selection create a downward spiral of higher premiums and a shrinking insurance pool, making everyone's health care less affordable. (5) The Mandate's Constitutionality The pivotal constitutional concern is that government will penalize individuals for failing to buy health insurance--for doing nothing--simply because they are legal residents of the United States. The states could undoubtedly mandate health coverage, as with the Massachusetts Health Care Reform Plan of 2006. But the federal government has limited power; its principal enumerated are to regulate interstate commerce and to tax for the general welfare. The Supreme Court, however, has broadly construed federal powers--known as the implied powers doctrine--to uphold laws that are necessary and proper. By this reasoning, the Court ought to uphold the constitutionality of the health insurance mandate. The power to regulate interstate commerce. The Supreme Court has interpreted the commerce power broadly, applying it to virtually every aspect of economic and social life. …

VITAL SIGNS: Rhode Island Leads U.S. in Health Insurance Mandates

VITAL SIGNS: Rhode Island Leads U.S. in Health Insurance Mandates

Vital Signs: Rhode Island Leads U.S. in Health Insurance Mandates

Vital Signs: Rhode Island Leads U.S. in Health Insurance Mandates

Vital Signs: Rhode Island Leads U.S. in Health Insurance Mandates

Vital Signs: Rhode Island Leads U.S. in Health Insurance Mandates