192775 Impact of an individual health insurance mandate on low income vulnerable populations

Monday, November 9, 2009: 11:15 AM

Michael Doonan, PhD , Schneider Institute for Health Policy, Brandeis University, Heller School, Waltham, MA
Katharine R. Tull , Schneider Institute for Health Policy, Brandeis University, Heller School, Waltham, MA
Individual mandates are a controversial tool for health reform. Evidence suggests that the only way to achieve near universal health insurance is through an individual mandate. Such a mandate can impose significant financial requirements on low income, vulnerable populations. With individual mandates a realistic option for emerging national and state level reform plans, this paper analyzes how an individual mandate can be constructed to expand coverage without undue financial burdens on low income individuals and families. This paper/session considers the evidence on take up rates for voluntary insurance programs, such as employer sponsored insurance, Medicaid, and the State Children's Health Insurance Program (SCHIP). It also evaluates expansions to these programs, such as Medicaid or SCHIP premium assistance and buy in programs. The data is compared to insurance enrollment rates in Massachusetts, the first state to mandate health insurance coverage for all adult residents. Health reform efforts in other states are discussed, including voluntary universal coverage in Maine and Vermont and employer mandated coverage in Hawaii. The paper then examines issues of how affordable insurance is defined, how subsidies can be structured and applied, and how penalties can be enforced were addressed and implemented in Massachusetts. Resolving these issues are critical to making a mandate an effective and equitable means of expanded insurance coverage.

Learning Objectives:
1. Compare take up rates in voluntary insurance programs to rates under mandated insurance provisions. 2. Identify critical issues for developing fair, effective insurance mandates, including affordability and subsidies. 3. Assess the relevant barriers to individual insurance mandates for reform in various states and nationally.

Keywords: Health Care Reform, Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Track Massachusetts health care reform on a daily basis as Executive Director of the Massachusetts Health Policy Forum. Drafted book chapter “Healthcare Insurance: The Massachusetts Plan.” The Business of Health Care, Volume 3. Eds: Kenneth H. Cohn, MD and Douglas E. Hough Ph.D. Westport: Praeger, 2008.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.