Potential Alternatives to the Individual Mandate


Potential Alternatives to the Individual Mandate

Tuesday, April 5th, 2011 - 9:36
Tuesday, April 5, 2011 - 08:59
A report from the Government Accountability Office presents nine potential alternatives to the individual mandate.

The GAO has come out with a report presenting potential alternatives to the individual mandate in the health reform law, should it be changed or eliminated by a court decision. The nine potential alternatives are presented in order of how often they were mentioned by health policy experts as potential replacements.

Getting Congress to agree on one or more of these replacements could be difficult. But here they are, with a brief description and commentary in some cases. It's important to note that these approaches were not always suggested by experts as being comparable in effect to the individual mandate.

1. Change open enrollment periods and add late enrollment penalties to provide a financial incentive not to delay in acquiring coverage. If open enrollment periods are less frequent -- perhaps every 18 months or every 2 years -- this would increase the risks of deciding to go without coverage.

2. Expand the roles of employers in enrolling their employees in coverage. Make the requirement for auto-enrollment of employees apply not only to large businesses that provide coverage, but to small businesses that don't. The smaller employees would be required to get employees enrolled in the state-level exchanges, for example. This proposal would seemingly raise significant opposition from the small business lobby.

3. Conduct public education and outreach campaign about the benefits of enrolling in coverage and the options for doing so. This would seem to be a pratical idea, although it should be noted that public education campaigns on health reform have faced difficulties in penetrating certain markets.

4. Provide personalized assistance for those attempting to enroll in health coverage. The training and payment of employees to provide personalized assistance would be significant, and it's unclear how or whether those costs would be shared between the states and federal government.

5. Put a tax on care provided to those who have signed up for coverage. A tax on emergency room visits for those without coverage could be levied based on income. However, many don't file taxes.

6. Provide more of a gap in premium rates for the young and the old. This would encourage more young adults between the ages of 19 and 29 to obtain coverage. Members of this group have been show to frequently go without coverage.

7. Make it so that certain government services can be provided only to those who can show proof of health insurance coverage. One example is conditioning federal college loans on proof of insurance. This would place verification responsibilities on public agencies.

8. Create different roles for health insurance brokers and agents. Enlist the help of brokers and agents in helping individuals determining eligibility and obtaining coverage through exchanges.

9. Require or encourage credit ratings agencies to use health coverage status in determining individuals' credit scores. This would require the agencies to investigate the interplay between health coverage status and credit-worthiness.