Senate Republicans are proposing to repeal the Affordable Care Act’s requirement that everyone buy insurance as part of their tax overhaul bill. This would have serious consequences for Louisiana’s health care system, especially older Louisianans who buy insurance through the individual marketplace.
The individual mandate helps ensure healthy Louisianans sign up for coverage, maintaining a balanced group of healthy and sick people that keeps the prices of health plans in the individual market down. Without the mandate, individual market premiums would increase by an average of 10 percent, according to the Congressional Budget Office. A study by the Commonwealth Institute, estimates that annual premiums for a 60-year old in Louisiana would rise by $1,165 in 2019 if the tax bill becomes law. Younger adults who buy coverage on the individual marketplace also would face substantial premium hikes.
The CBO estimates the number of Americans without health insurance would increase by 13 million if the individual mandate were repealed. Analysts at the Center for American Progress estimate that 197,000 fewer Louisiana residents would have coverage by 2025 if the mandate is repealed. Some of the coverage losses would result from people simply choosing to forgo health insurance. But others would lose coverage because of an inability to pay.
Health navigators who help people sign up for coverage report that a number of people sought insurance because of the mandate, only to receive a significant health diagnosis in short order, with their new health coverage being critical to their care and financial well-being. Others may be unaware that they can get a relatively inexpensive health plan due to the generous subsidies available.
People who are uninsured – either by choice or economic circumstance – lack access to preventive care, are less likely to receive needed care, have worse health outcomes, and can face financial ruin if they do get seriously ill and seek treatment. As Sen. Bill Cassidy pointed out in an op-ed in The Hill in March, many of those who go uninsured ultimately will get sick and need care, but they will be unable to pay for it, leaving that care to be paid for by other consumers.
A recent Kaiser Family Foundation survey found that 55 percent of the public supports the repeal of the individual mandate, down from 63 percent who supported repeal 2016. But when people are given more information about the mandate – including the potential consequences of repeal – support rises significantly. When given this new information, 6 in 10 respondents said they opposed repealing the individual mandate.
In other words: When people understand the reasons for the mandate and the consequences of repeal, a majority of them support keeping it in place. This was a lesson the Senate learned last summer, when the “skinny repeal” legislation was rejected amid opposition by governors of both parties, health insurers, physicians, patient advocates and policy experts.
Members of Congress, especially in Louisiana, should again reject this ill-conceived proposal.