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Nine alternatives to the individual mandate

While the US Supreme Court considered the constitutionality of this issue today, what’s lost in much of the commentary is that encouraging people to purchase health coverage doesn’t require such a mandate.   Put simply, the health law survives without the responsibility requirement with other mechanisms that make it cheaper and easier to just buy coverage.

After all, think about it – most (80%+) people have coverage already, either through their job or Medicare/Medicaid – so it’s a pretty small percentage affected by the requirement.  And, in Massachusetts, where then-Governor Romney passed an individual mandate as part of their health care law four years ago, almost 98% of people have insurance and the requirement to buy coverage has been supremely uncontroversial [1].

So what are the alternatives?  The simplest is just to really penalize people who wait to buy health coverage until they get sick or enroll later than everyone else.  You can still buy coverage, but it just won’t cover as much and it will cost a lot more.  We already do that in the Medicare program for physician services coverage and it works very well.   See the GAO report for all the nine alternatives [2].