Starting in 2019, the Affordable Care Act's individual mandate penalty will be eliminated, effectively ending the law's requirement that most people have health insurance. While declines in coverage and increases in premiums are likely, the magnitudes of these effects are highly uncertain.
The new tax law eliminates the individual mandate. When this repeal takes effect in 2019, millions more Americans are expected to go without health insurance. Auto insurers will likely pick up the tab for some of that population's medical care. That could raise car insurance premiums.
The issue of how to improve health care in the United States is complicated. At a RAND event, senior economist and Paul O'Neill Alcoa Chair in Policy Analysis Christine Eibner discussed modifications to the Affordable Care Act and the long-term outlook for health care reform.
Americans expect affordable coverage for pre-existing conditions, access to routine services, and protection from unpredictable and significant financial risk from accidents or illness. As a product designed primarily for risk protection, insurance may not be the most efficient or affordable approach to achieving all of these objectives.
Doctors recommend exclusive breastfeeding for the first six months of a baby's life. This provides health benefits to both mother and child and saves health care costs. Paid maternity leave can boost breastfeeding rates, but few U.S. firms offer it.
As Congress considers repealing and replacing the Affordable Care Act, it will need to consider how federal budget scoring can affect the fate of legislation. Depending on the ultimate cost of a replacement, finding enough savings to offset costs while maintaining budget neutrality could make it hard to pass a replacement.
A continuous coverage requirement is intended to discourage individuals from waiting until they become sick to purchase insurance. Such a requirement works well in theory to maintain a healthy marketplace, but there is little evidence on how well it might work in practice.
The impact of RAND's Health Insurance Experiment has been wide-reaching. The study's conclusions encouraged the restructuring of private insurance and helped increase the stature of managed care in the United States.
The ACA encourages workers to retain employer coverage by restricting their eligibility for marketplace subsidies. Modifying the policy could help 700,000 people gain coverage and lower spending for 1.6 million who are insured but face high health care costs under current ACA policy.
As policymakers consider alternatives to reduce the federal government's financial burden from providing subsidies under the ACA, they should consider the consequences for enrollees. Existing premium-support models yield considerable savings for the federal government but could create age and income disparities in coverage.