Experts float alternatives to individual mandate

It's likely Judge Henry Hudson in Virginia was only the first of many federal judges who will try to strike a blow at the individual mandate provision of the health reform law passed last March. So it's not surprising that health policy experts are floating possible Plan B ideas just in case the mandate, which requires everyone purchase health insurance beginning in 2014, is struck down or substantially weakened, as Kaiser Health News reports.

A "carrots and sticks" approach could be as effective in getting as many people as possible covered, according to Gail Wilensky, former head of Medicare and Medicaid under President George H.W. Bush. One model to emulate is Medicare's drug benefit that charges more if people don't elect to get coverage when they first become eligible, but decide to do so later.

"The idea is to raise the ante for people who wait until they are sick to buy insurance," Wilensky said. "That would change the dynamics and may be more effective than a wimpy mandate," she told KHN.

Under the reform law, in 2014, the penalty an individual could owe for not having insurance might be as little as $95. By 2015, it could be $695 or 2.5 percent of taxable income, whichever figure is higher.

One backup plan that reform advocates have suggested would be an opt-out rule to allow people to forgo insurance, the Mother Jones blog reports. But it also would offer benefits, such as government subsidies to buy insurance, under health reform to those who chose to be covered.

Some observers like Mark Pauly, a healthcare economist at the University of Pennsylvania's Wharton School, find the mandate's penalties too mild to compel resisters to buy insurance. He was among several researchers who proposed the individual mandate idea while still serving in the first Bush administration, according to KHN.

He doesn't like the way the mandate, paired with new rules, makes it possible for people to delay buying coverage until they get sick, which is behavior the overhaul is designed to discourage.

Still, Pauly thinks a mandate is vital. Risk ultimately catches up with the risk takers, he said. And someone always has to pay. Added Pauly: "You need a mandate because there will be some Evel Knievels of health insurance."

To learn more:
- read the Kaiser Health News story
- check out this blog post at Mother Jones
- here's the New York Times article

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