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The Mandate: Without the “individual mandate” 1 million fewer Californians will enroll in health care reform coverage programs

January 20, 2012

  • UCLA Center for Health Policy Research

    New Center study central to amicus brief submitted to U.S. Supreme Court defending the mandate

    In advance of a March 2012 U.S. Supreme Court case on the constitutionality of the “individual mandate” –  the requirement specified in the health care reform that all Americans purchase some type of health insurance coverage – the Center has released a new study​ that shows that without this mandate up to one million or more Californians will go without health insurance.

    The study was funded by The California Endowment and used in an “amicus” or “friend of the court” brief filed this month with the United States Supreme Court in support of the constitutionality of the mandate and the Affordable Care Act, the new federal health care law. The Supreme Court recently agreed to hear oral arguments in late March 2012 for one of the many federal court challenges to the Affordable Care Act (Department of Health & Human Services v. Florida etal.).

    The mandate – officially known as the “minimum coverage requirement” – is seen as unconstitutional by some and by others as an essential means of controlling health care costs by compelling all Americans, not just those with health problems, to participate in the health care system.

    However a new Center policy note uses a micro-simulation model to estimate that the number of newly insured under health care reform will be 1.04 million lower in 2019 without the mandate. 

    Specifically, the report’s authors predict that without the mandate, health care reform will reduce the state's eligible uninsured population from 4.63 to 3.76 million; a reduction of only 870,000 or approximately 19 percent of all those eligible for coverage.

    By contrast, with the mandate, health care reform will reduce California's eligible uninsured population from 4.63 to 2.72 million by 2019; a reduction of 1.91 million or 41 percent of the eligible uninsured. 

    “There’s no question that the mandate makes a huge difference in bringing people under the umbrella of coverage,” said Gerald Kominski, director of the UCLA Center for Health Policy Research, which conducted the study in collaboration with the University of California, Berkeley Center for Labor Research and Education.  “Eliminating the mandate will undermine the goal of health care reform to substantially increase health insurance coverage for the uninsured.”

    The authors note that an additional negative consequence of eliminating the mandate will be “adverse selection” – a phenomena where only those with serious (and costly) health conditions enroll in health insurance, thus driving up premium growth.  If this occurs, the number of the state’s eligible uninsured will potentially reduce even further: From 4.63 to 4.02 million by 2019; a reduction of only 610,000 or 13 percent of the eligible uninsured. 

    As a result, the number of newly insured will be 1.30 million lower in 2019 without the mandate and with higher premiums due to adverse selection. 

    The study was conducted based on analyses using the California Simulation of Insurance Markets (CalSIM) model, a micro-simulation developed by Center and Berkeley researchers, that uses a range of official data sources (including the California Health Interview Survey) to estimate the impact of various elements of the ACA on employer decisions to offer insurance coverage and individual decisions to obtain coverage in California.

    Read the policy note: Newly Insured Californians Would Fall by More than 1 Million under the Affordable Care Act without the Requirement to Purchase Insurance​

    The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health-related information on Californians.  

    The UC Berkeley Center for Labor Research, a public service and outreach program of the UC Berkeley Institute for Research on Labor and Employment, was founded in 1964 to conduct research and educate on issues related to labor and employment, such as job quality and workforce development. 

    The California Endowment, a private statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians.