Thursday, July 19, 2012

Affordable Care Act's Individual Mandate Upheld: Why the Sky Isn't Falling

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To listen to some American citizens, politicians and pundits you'd think the sky was falling down around our ears in the wake of the US Supreme Court's decision upholding most provisions of the 2010 Patient Protection and Affordable Care Act (ACA).

The individual mandate seems to have drawn the most criticism and confusion. Who will be affected by it and how? In a nutshell, very few people will be affected, but Americans with lower incomes will get some much needed help with their medical costs.

Researchers from the Urban Institute estimate a mere 6 percent of Americans will be affected by the individual mandate requiring every citizen to buy insurance.
  • Among the 26 million individuals making up that 6 percent, approximately 8 million will be eligible to receive free or nearly free coverage through Medicaid or the Children's Health Insurance Program (CHIP), both of which satisfy the individual mandate. 
  • Only 2 percent of the entire population will be offered no financial assistance in obtaining insurance coverage to comply with the individual mandate or face the penalty. 
  • Approximately 55 to 57 percent of Americans will be receiving their insurance through an employer. None of the millions of Americans in this category would need to worry about the individual mandate.

A few different kinds of exemptions from the individual mandate are available to the 6 percent of the population affected by it. These include:
  • Religious opposition.
  • Undocumented immigrant status.
  • Incarceration.
  • Membership in an Indian tribe.
  • A family income below the threshold requiring you to file a tax return.
  • Paying more than 8% of your income for health insurance after taking into account any employer contributions or tax credits.
If you're still unclear about whether you'll be required to purchase insurance starting in 2014, the Kaiser Family Foundation offers an easy to use flowchart to take you through the options: The Requirement to Buy Coverage Under the Affordable Care Act.

There is a fair point being made by those who do not believe the federal government should be able to compel anyone to purchase health insurance. But the law does not penalize poor or unemployed people for not being insured, as I've heard some claim it does. Nor does it represent a government takeover of health care. Our system will continue to be based on a mix of private and public options. But I predict 2010 will be a noteworthy year in American history as a turning point for patients rights. I think we'll look back and wonder why this wasn't done sooner rather than wishing we'd not done it at all.

For more information about the new protections afforded patients under the ACA, please read my article: Migraine Patients & Health Reform: How Are You Affected?

1. Blumberg, Linda J.; Buettgens, Matthew; and Feder, Judy. The Individual Mandate in Perspective. Urban Institute. March 2012.
2. Buettgens, Matthew; Garrett, Bowen; and Holahan, John. America Under the Affordable Care Act. Urban Institute. December 2010.
3. "The Requirement to Buy Coverage Under the Affordable Care Act," Kaiser Family Foundation, accessed July 12, 2012,
4. Eve Troeh "For Americans insured by employers, not much will change" Marketplace, accessed July 12, 2012,

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DISCLAIMER: Nothing on this site constitutes medical or legal advice. I am a patient who is engaged and educated and enjoys sharing my experiences and news about migraines, pain and depression. Please consult your own health care providers for advice on your unique situation.