Patient Financial Services



The Affordable Care Act's individual mandate—which required consumers to enroll in health insurance or pay a penalty fee—has been at the forefront of health care reform debate for years. And while a federal tax bill passed in late 2017 reduced the mandate's financial penalties to zero, beginning in 2019, it doesn't look like the individual mandate is out of sight just yet.

While the fines for the mandate have been reduced to zero at the federal level, the mandate itself and its requirement to carry health insurance will remain part of the Affordable Care Act. However, without the fines, there are no federal regulations in place to hold consumers accountable for complying with the mandate.

The Congressional Budget Office (CBO) estimates that, as a result, 4 million people will choose not to enroll in coverage in 2019 and that the number will only grow from there—with 13 million ultimately becoming uninsured. It's speculated that a large number of those would likely be healthier consumers, threatening the stability of the marketplaces. This is expected to drive increases in premiums at a rate of 10% a year, beginning in 2019.

States are responding in a variety of ways. Some are pursuing state-level proposals to enact provisions similar to the individual mandate, while others are looking to eliminate the mandate all together.

  • Nine states have passed or are pursuing their own requirements, including California, Connecticut, Hawaii, Minnesota, New Jersey, Rhode Island, Vermont and Washington, as well as the District of Columbia.
  • New Jersey recently passed its bill to reinstate the individual mandate, becoming the second state to do so.
  • Maryland began pursuing its own innovative approach to similar legislation earlier this year. The bill would require those who choose not to buy a plan to pay an annual fine starting at $700. They would then have the option to use that fine as a down payment to purchase insurance the following year.
  • Ohio became the first state to request a waiver to eliminate the individual mandate all together, submitting paperwork in late March to the Department of Health and Human Services. If approved, Ohio would become the first state to receive a 1332 waiver of the individual mandate.

At the consumer level, it's likely many don't know that the individual mandate was waived. In other cases, consumer stories have surfaced that consumers have already dropped coverage, thinking the changes at the federal level would immediately eliminate the penalty fees.

Whatever the outcome at the state level, there's no doubt this will continue to be a pain point for both consumers and providers as they try to navigate the ever-changing health care landscape.