Subsequent RAND analysis conducted in the early enrollment period underscored the provision’s importance to promoting the ACA’s goal of universal health care coverage. The Supreme Court upheld the provision’s constitutionality, interpreting the penalty as a lawfully imposed tax. In the run-up to the court decision, RAND analyzed the likely effect of eliminating the individual mandate and found that without it, an estimated 12 million people who would otherwise sign up for coverage would be uninsured. The plaintiffs sued to have the individual mandate voided as unconstitutional. Early in the policy debate over competing legislative designs for reforming the health care system, analysis using RAND’s COMPARE model showed that the individual mandate would be a powerful policy lever in encouraging the uninsured to get coverage.Īfter the law was enacted, the Supreme Court took up a legal challenge to the individual mandate. One of the law’s most controversial provisions, this mandate requires that most adults must have coverage or pay a fine. One of the reasons why people are signing up is the individual mandate. The Individual Mandate Is Effective as an Incentive to Enroll The study also estimated that 125.2 million Americans-about 80 percent of the nonelderly population that had insurance in September 2013-experienced no change in the source of insurance during the period. Among those newly insured, 9.6 million people enrolled in employer-sponsored health plans, followed by Medicaid (6.5 million), the individual marketplaces (4.1 million), nonmarketplace individual plans (1.2 million) and other insurance sources (1.5 million). Much of this increase was driven by gains in employer-sponsored coverage. The total number of uninsured Americans dropped from 42.7 million to 25.8 million. Notwithstanding widely reported problems with the rollout of the Marketplace websites, sizable numbers of previously uninsured people were able to obtain coverage over the first and second enrollment periods.Īnalysis of survey data about Americans' health insurance enrollment from October 2013 to April 2015 showed that 22.8 million Americans became newly insured and 5.9 million lost coverage, for a net of 16.9 million newly insured Americans. More than three years after the law's enactment, enrollment in the online Marketplaces began in October 2013. What makes this tool unique is its ability to follow the same nationally representative sample of individuals from month to month to identify changes in their health care coverage as well as shifts in opinion and knowledge about the ACA.īelow we highlight what we have learned from our studies of the ACA to date as implementation continues to unfold. , we developed an innovative survey tool, the Health Reform Opinion Survey, to monitor enrollment trends following the opening of the new marketplaces and to track shifts in public opinions and knowledge about the ACA. , a microsimulation modeling tool that allows us to estimate the likely effects of policy changes in key areas of health reform on key outcomes, including health coverage, employer-based insurance, consumer costs, and government spending. To understand the impact of these developments and to monitor the effects of the ACA, RAND used COMPARE Implementation of the ACA has been marked by controversy and unexpected twists and turns, including court challenges and delays in key provisions.
These included reducing payments to hospitals for some Medicare services and promoting experimentation with new payment and delivery models.
The ACA also mandated new approaches to reducing costs and improving quality, many focused on Medicare and Medicaid populations.