Figuring out how killing the Affordable Care Act individual health insurance mandate might affect individual major medical enrollment is trickier than it sounds.
One problem is that an individual health insurance market with a repealed mandate might be different from a market that never had a mandate in the first place, according to Alexandra Minicozzi, an analyst at the Congressional Budget Office.
Minicozzi, unit chief for the CBO's health insurance modeling unit, talks about the challenges facing ACA mandate repeal forecasters in a new meeting slidedeck.
The drafters of the bills that created the ACA eliminated many of the tools, such as shutting out sick people, and charging higher premiums for sick people, that health insurers once used to manage claim risk.
In an effort to offset some of the effects of those changes, the ACA drafters created an "individual shared responsibility" provision. That provision requires many people to have what the government classifies as "minimum essential coverage," or solid major medical coverage, for much of the year, or else pay a penalty.
The ACA individual mandate offers many types of exemptions.
Only 4.8% of the taxpayers and known nonfilers without minimum essential coverage in 2015, or about 17% of the taxpayers and known nonfilers who might have been expected to pay the individual shared responsibility penalty for 2015, actually paid the penalty, according to Internal Revenue Service data included in Minicozzi's slidedeck.
